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Full text of "Report of the Health Department of the Panama Canal for the calendar year"



REPORT 

OF THE 



Health Department 



OF 



The Panama Canal 

FOR THE 

CALENDAR YEAR 
1931 

Gift of the Panama Canal Museum 




J. F. SILER 



Colonel, Medical Corps, United States Army 
CHIEF HEALTH OFFICER 



BALBOA HEIGHTS, CANAL ZONE 



THE PANAMA CANAL PRESS 

MOUNT HOPE, C. Z. 

1932 



REPORT 

OF THE 



Health Department 



OF 



The Panama Canal 

FOR THE 

CALENDAR YEAR 
1931 




J. F. SILER 

Colonel, Medical Corps, United States Army 
CHIEF HEALTH OFFICER 



BALBOA HEIGHTS, CANAL ZONE 



THE PANAMA CANAL PRESS 

MOUNT HOPE, C. Z. 

1932 




or BaKHeSfclSz^ 13 Pllb ' ication addr ^ The Panama Canal, Washington. D. C. 



CONTENTS. 

Page. 

Title - - - 1 

Organization and activities 5 

Personnel 5 

Financial statement 7 

Vital statistics, populations of the Canal Zone, Panama City, and Colon 10 

General death rates, all causes, and from disease only: 

Canal Zone 11 

Panama City 13 

Colon. ._ : 15 

Birth rates: 

Canal Zone 16 

Panama City. 18 

Colon ^_ - 19 

Infant mortality rates, Canal Zone, Panama City, and Colon 20 

Principal causes of death : 

Canal Zone 21 

Panama City 22 

Colon 23 

Acute transmissible diseases reported in 1931 23 

Vital statistics, Panama Canal employees = 25 

Death rates, all causes.. 26 

Death rates, disease only.. 27 

Admission rates to hospitals and quarters 28 

Principal causes of admission to hospital 29 

Noneffective rates, all causes 30 

Admission rates, malaria 31 

Admission, death, and fatality rates, malaria, by race... 34 

Death rates, malaria 35 

Division of Hospitals, Dispensaries, and Charities 36 

Annual Report, Gorgas Hospital, 1931... 37 

Annual Report, Board of Health Laboratory, 1931 38 

Annual Report, Colon Hospital, 1931... 45 

Annual Report, Corozal Hospital, 1931 46 

Annual Report, Palo Seco Leper Colony, 1931 49 

Division of Sanitation: 

Organization and activities 50 

Routine and special activities undertaken during 1931 50 

Routine activities 50 

Special projects undertaken in 1931 50 

Medical care of the population in the Madden Dam area 50 

Anopheline mosquitoes of the Isthmus 52 

Special projects undertaken in Northern District 55 

Special projects undertaken in Southern Division — Pedro Miguel, 

Ancon-Balboa, and Panama-Suburban Districts... 55 



CONTENTS— Continued. 

Page. 
Division of Sanitation — Continued: 

Malaria in colored settlers (farmers) living in the Canal Zone.. 56 

Mosquito breeding areas in the vicinity of Panama City, and their con- 
trol by dusting with Paris green from airplanes 59 

Drainage work 64 

Trypanosomiasis in animals 66 

Experiments in composting manure 68 

Disposal of garbage, Pacific entrance to the Canal 68 

Health services in the terminal cities, Panama and Colon 69 

Annual Report, Health Officer, Panama City 69 

Annual Report, Health Officer, Cristobal-Colon...... 71 

Annual Report, Division of Quarantine 79 

Annual Report of the District Nurse 81 

Medical examination of school children 82 

Lead poisoning 83 

General Tables: 

1. Discharges from hospitals, deaths, and noneffective rates for em- 

ployees..- 85" 

2. Causes of deaths of employees arranged with reference to color, 

age, and length of residence on Isthmus 86 

3. Deaths and death rates of residents of the Canal Zone and the 

cities of Panama and Colon. _ 88 

4. Deaths of residents of the Canal Zone and the cities of Panama and 

Colon, by cause, sex, color, and age... 90 

5. Deaths of residents of the Canal Zone and the cities of Panama 

and Colon, by place of residence, absolute numbers and 

annual rates per 1,000 96 

6. Deaths of nonresidents by cause, sex, color, and age 102 

7. Statistics regarding American employees and their families 104 

8. Discharges and deaths in hospitals of The Panama Canal, absolute 

numbers... 106 

8-A. Discharges and deaths in hospitals of The Panama Canal, rates 

per 1,000 population 116 

9. Consolidated hospital and colony report. 125 

10. Number of days hospital treatment furnished, and average number 

in hospital each day of the various classes of patients 126 

11. Consolidated admission report, hospitals and dispensaries 126 

12. Report of dispensaries 127 



CALENDAR YEAR REPORT, 1931. 
HEALTH DEPARTMENT. 

ORGANIZATION AND ACTIVITIES. 

The Health Department is one of the five departments of the Panama 
Canal organization functioning directly under the Governor. It is 
charged with sanitation and the control and prevention of transmissible 
diseases in the Canal Zone and in Panama City and Colon, the treat- 
ment and hospital care of United States Government employees and 
their dependents, and others entitled to such care, the enforcement 
of quarantine regulations and the compilation of vital statistics for the 
Canal Zone and the cities of Panama and Colon. 

Its activities are conducted under the four principal divisions indi- 
cated in the organization chart on the following page. 

The administrative functions and activities of the various divisions 
were described briefly in the annual report for 1930. 

PERSONNEL. 

As the Panama Canal hospitals are used as general hospitals for the 
care of sick and injured military personnel of the Army on duty in the 
Panama Canal Department (military), a number of officers of the 
Medical Department of the Army (32 physicians and 1 dentist) ordi- 
narily serve for a tour of duty of three years with the Panama Canal. 
During the year the usual changes incident to termination of tour of 
duty of such personnel have occurred. The principal changes in 
personnel assigned to key positions during the year as a result of ter- 
mination of assignments, have been as follows: 

Superintendent of Colon Hospital, Maj. H. P. Makel, relieved by 
Maj. D. F. Winn. Chief of Medical Service, Gorgas Hospital, Maj. 
H. C. Dooling, relieved by Lieut. Col. E. R. Gentry. Assistant to 
Superintendent, Gorgas Hospital, Maj. J. W. Sherwood, relieved by 
Lieut. Col. William L. Sheep. 



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The total personnel in the service of the Health Department on 
December 31, 1931, by units, as compared with the strength for pre- 
ceding four years, is shown in the following table: 

FORCE REPORT, HEALTH DEPARTMENT, FOR DECEMBER, EACH YEAR. 



1927. 



1928. 



1929. 



1930. 



1931. 



Chief Health Office 

Gorgas Hospital 

Colon Hospital 

Corozal Hospital 

Line dispensaries 

Palo Seco Leper Colony . 

Quarantine service 

Health Office, Panama. . 
Health Office, Colon.... 
Zone Sanitation 



Total . 



261 



6 

411 
61 

136 
21 
38 
35 

136 
98 

147 



5 
166 

24 

21 

14 

1 

12 
10 



259 
38 

126 

9 

37 

25 

125 
85 

124 



5 

425 
62 

147 
23 
38 
37 

135 
93 

129 



267 
54 

141 
15 
28 
20 

118 
87 

117 



8281,089 266 



S2S 



282 



891 



1,173 



279 



847 



7 

434 
83 

163 
31 
29 
31 

129 
96 

123 

1,126 



284 



826 



7 

412 
87 

159 
32 
29 
32 

129 
97 

126 

1,110 



Note.- — "Gold" are white American employees, with the exception of two white aliens and one colored alien. 
"Silver" are alien employees, principally West Indians (colored). 

The distribution of the gold personnel, on the basis of professional 
or other qualifications, was as follows: 



32 physicians, medical officers of the 

U. S. Army. 
1 physician, surgeon of the U. S. 

Public Health Service. 
31 physicians, civilian. 

1 dentist, U. S. Army. 
11 internes. 

9 male nurses. 
105 female nurses. 

2 district nurses. 
35 clerks. 

11 sanitary inspectors. 

1 sanitary assistant. 

2 quarantine inspectors. 
5 veterinarians. 

8 technicians. 



8 dispensary assistants. 
5 pharmacists and assistant phar- 
macists. 
2 chemists 
2 general mechanics 

2 stewardesses. 

3 dietists. 

1 storekeeper. 
1 dental hygienist 
1 vaccinator. 
1 carpenter foreman. 
1 chauffeur foreman. 
1 physio-therapy aide. 
1 electrician. 
1 embalmer. 



FINANCIAL STATEMENT. 

The funds for the operation of the Health Department consist of 
direct appropriations from the Congress and earnings from various 
sources. 



Operating Expenses and Earnings of the Health Department, 
Calendar Year 1931. 





Operating 
expenses. 


Earnings 


Per cent 
self 

support- 
ing. 


Gross 
cost 
per 

patient 
per day. 


Gross cost per 
patient per day 
after distribu- 
tion of expenses 

of Board of 
Health Labora- 
tory. « 


Gorgas Hospital 


'$836,860.67 
'182,015.74 

3181,024.26 
47,214.57 
578,823.48 

778,025.27 

139,375.37 

144,018.98 

91,649.29 

8,279.61 

^40,557.61 
1,827,845.00 


$388,700.91 
95,094.35 

161,651 95 
20,759.50 
25,305.76 

11,740.42 

8 113,907.24 
47,291.10 
28,045.25 


46 

52 

89 
44 
32 

15 

82 
33 
31 


$5.07 
4 39 

.70 
1.35 


|4 83 


Colon Hospital 


4 65 


Corozal Hospital (for the in- 
sane, chronics and cripples).. 

Palo Seco Leper Colony 

Maritime Quarantine Service .. 


.72 
1.36 


Sanitation of Panama City 
and Colon 






Street cleaning and garbage 
collection and disposal, Pan- 
ama City and Colon 






Canal Zone sanitation 






Line dispensaries . 






Medical storehouse 






Chief Health Office and mis- 
cellaneous 


2,312.63 
894,809.11 


6 
49 






Total 6 













1 Includes Army pay of Army medical officers on duty in this institution which amounted to $125,555.4'J 

Also includes cost of operation of Board of Health Laboratory. 

2 Includes Army pay of Army medical officers on duty in this institution which amounted to 26,502.60 

Also includes cost of operating Colon Dispensary. 

> Includes Army pay of Army medical officers on duty in this institution which amounted to 15,305.54 

4 Includes Army pay of Chief Health Officer which amounted to 7,200.00 

Total Army pay of Army medical officers on duty in Health Department 174 ,563 . 63 

s Includes Public Health Service pay of Public Health Officer acting as Chief Quarantine Officer, which 

amounted to 5,457.00 



6 Includes Army and Public Health Service pay, which amounted to 180,020 63 

7 Includes 15,289 transferred to fine fund. 

8 Earnings include the 75 per cent of total expense, plus 10 per cent overhead, which is billed against the 

Republic of Panama. 
' The Board of Health Laboratory is under the administrative jurisdiction of Gorgas Hospital for economy 
of operation and accounting, all expenses thereof being charged to Gorgas Hospital. This 
causes the cost per patient per day at Gorgas Hospital to appear higher than it actually is. 
Only about one-half of the work of the Laboratory is for Gorgas Hospital, and in order to arrive 
at a more accurate figure of cost per patient per day, the expenses of the Laboratory have been 
prorated to the hospitals on the basis of amount of work done for them, resulting in the revised 
figures shown for cost per patient per day. 

Operating Expenses of the Health Department, Calendar Yeak 1931, 
Showing Amounts Charged to Various Accounts. 
Gold pay roll (white employees): 

Panama Canal pay 

Army pay_ 

Public Health Service pay 



$677,097.30 

174,563.63 

5,457.00 



Silver payroll (colored employees).. 

Subsistence supplies 

Ice 

Hospitals supplies and drugs 

Equipment 

Miscellaneous material and supplies 



$857,117.93 

439,969.10 

210,769.70 

4,537.50 

78,749.03 

16,167.86 

44,522.14 



INCOME 



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a P/ATIENT-DAY5 



Laundry __ 

Telephones 

Repatriation of patients physically or mentally disabled 

Medical storehouse operation 

Launch service 

Mechanical Division repairs, oxygen, and new launch for Palo Seco ... 

Electric current.. 

Electric repairs and installations _ 

Water _ 

Freight 

Motor transportation charges (except for hospitals, quarantine 
station, and dispensaries which operate their own motor vehi- 
cles) 

Repairs to motor vehicles of hospitals, dispensaries and quarantine 
station _ 

Rentals of quarters 

Building repairs and minor construction 

Miscellaneous charges 



$39,255.14 

14,749.90 

423.17 

8,279.61 

6,289.85 

8,485.59 

14,799.10 

3,347.21 

12,339.94 

1,806.72 



49,019.47 

1,912.73 
1,862.21 
3,918.23 
9,522.87 



Total expenses 1,827,845.00 

The funds for the operation of the Health Department consist 
of direct appropriations from Congress and earnings from various 
sources. The extent to which the Health Department has been self- 
supporting during the calendar years 1923 to 1931 inclusive, is shown 
in the following table: 





Gross operating 
expenses. 


Earnings. 


Per cent 
self-supporting. 


1923 


$1,415,944.19 
1,476,385.27 
1,430,484.91 
1,542,473.15 
1,628,376.14 
1,821,696.73 
1,902,222.27 
1,910,689.69 
1,827,845.00 


1685,596.02 
703,137.81 
721,005.34 
755,843.70 
860,926.35 
937,469.38 
1,022,940.76 
995,733.57 
894,809.11 


48 


1924 


48 


1925 


50 


1926 


49 


1927 


53 


1928 


51 


1929 


54 


1930 


52 


1931 


49 



The extent to which the various units of the Health Department 
were self-supporting during the years 1923-1931 is indicated in the 
following table: 





Per cent self-supporting 
(Army pay included) 

Calendar years — 




1923. 


1924. 


M25. 


1926. 


1927. 


1928. 


1929. 


1930. 


1931. 




50 
39 
82 
39 
31 
60 

13 

51 
43 

48 


52 
41 

81 
40 

27 
38 

17 

58 
39 

48 


53 
39 
82 
45 
34 
46 

20 

60 
37 

50 


51 
37 
80 
38 
35 
53 

18 

61 
29 

49 


57 
44 
85 
46 
32 
35 

11 

81 
29 

53 


54 
44 
76 
41 
34 
38 

13 

82 
29 

51 


52 
52 
88 
46 
35 
49 

16 

82 
37 

54 


49 
59 
86 
55 
32 
35 

12 

81 
36 

52 


46 




52 




89 


Palo Seco Leper Colony 


44 
31 


Quarantine Division 

Sanitation, Panama and 


32 
15 


Street cleaning and garbage 
collection and removal, 
Panama City and Colon . 


82 
33 


Health Department 'as a 
whole 


49 



10 



The average cost per patient per day for hospital care and treatment 
in the various Panama Canal hospitals during the calendar years 1927 
to 1931 has been as is indicated in the following table. These costs 
include operations, maintenance, and full salaries (that is, including 
the Army pay of Army medical officers assigned to the various hos- 
pitals), and the cost of operating the Board of Health Laboratory. 
Capital charge for construction, interest on physical plant values, and 
amortization charges are not included: 





Calendar years. 




1927. 


1928. 


1929. 


1930. 


1931. 


Gorgas Hospital: 

(a) Including cost of Ancon Dispensary until September, 1929; 


4.66 
4.40 


4.66 
4.44 


5.08 
4.87 


5.40 
5.16 


5.07 


(fc) Including cost of Ancon Dispensary until September, 1929, 
but excluding cost of the Board of Health Laboratory 
chargeable to other divisions and outsiders 


4.83 


Colon Hospital: 


6.15 
6.70 


6.43 
6.96 


5 18 
5.55 


4.27 
4.5f 


4.39 


(6) Including cost of Colon Dispensary; al90 including the cost 
of the work done for this hospital by the Board of Health 


4.65 






Corozal Hospital: 

(a) Including cost of operation of dairy until December, 1930; 

also including cost of operating gardens and cemetery 

(6) Same as above, also including cost of the work done for this 


.94 
.96 


1.00 
1 03 


.90 
.92 


.88 
.90 


.70 
.72 








1.20 
1.21 


1.39 
1.40 


1.25 
1 26 


1.06 
1.07 


1.35 


(6) Including cost of the work done for this i:istitution by the 


1.36 







VITAL STATISTICS— POPULATIONS OF THE CANAL ZONE, 
PANAMA CITY, AND COLON. 



The Health Department of the Panama Canal secures, analyzes 
and makes reports on the vital statistics (births, deaths, and disease 
rates) of three geographical units of the population residing on the 
Isthmus of Panama, namely, the population of the Canal Zone, of the 
city of Panama, and of the city of Colon. 

Properly to interpret these statistics, it is essential that there be some 
understanding of the composition of the various units of the popula-* 
tion, their movement, and some of the special local factors involved 
which usually are not encountered in stabilized populations of com- 
munities in the various parts of the world. 

The special factors involved were discussed somewhat in detail in 
the annual report of the Health Department for 1930 (pages 12 to 15, 
inclusive). This report can be obtained on request to the Chief 
Health Officer, Balboa Heights, Canal Zone. 



11 

The Republic of Panama takes a census every 10 years, the last 
enumeration having been made in 1930. h\ Panama City, from 1920 
to 1930, the population made an average increase per year of almost 
exactly 1,500, and that figure has been used as the factor in computing 
the population each year by arithmetical progression, using the 1920 
and 1930 census figures as the bases. For 1931, the factor was again 
added to the 1930 census total, and 76,000 was adopted, the round 
numbers to indicate an estimate and not actual enumeration. 

In Colon, from 1920 to 1930, there was an average decrease of 150 
per year, and that figure has been used as the factor in computing 
the population each year by arithmetical progression, using the 1920 
and 1930 census figures as the bases. As there is some doubt as to 
the accuracy of the 1930 census of Colon, 30,000 was adopted for 1931. 

The population of the Canal Zone consists of white American em- 
ployees and their families, colored alien employees and their families, 
military and naval garrisons, representatives of shipping companies, 
contractors, church and welfare workers, etc., and colored alien agri- 
culturists who rent land under revocable licenses. 

The term "employees" as used in Health Department reports in- 
cludes employees of the Panama Canal proper and the Panama Rail- 
road Company, which is a corporation owned by the United States 
Government. 

GENERAL DEATH RATES, ALL CAUSES, AND FROM 
DISEASE ONLY. 

Population, Canal Zone. — Death rates from all causes are available 
since the beginning of construction (1905) and those from disease only 
are readily available since 1913. These data are incorporated and 
shown graphically in the two tables following: 



12 



Deaths from all Causes, Canal Zone Population (Employees and 
• Nonemployees) . 
Absolute numbers and rates per 1,000 of population. 







Deaths 


Rate 


Year. 


Popula- 


from all 


per 




tion. 


causes. 


1,000. 


1905 


23,463 


828 


35.29 


1906 


34,095 


1,700 


49.86 


1907 


54,036 


1,708 


31.60 


1908 


67,146 


1,273 


18.95 


1909 


76,900 


1,025 


13.33 


1910 


86,465 


1,251 


14.47 


1911 


90,434 


1,385 


15.32 


1912 


79,279 


1,129 


14.24 


1913 


61,700 


1,047 


16.97 


1914 


46,379 


710 


15.31 


1915 


31,496 


410 


12.83 


1916 


31,447 


343 


10.91 


1917 


33,044 


328 


9.93 


1918 


33,803 


286 


8.49 


1919 


32,366 


247 


7.63 


1920 


27,459 


242 


8.81 


1921 


31,377 


236 


7.52 


1922 


31,098 


254 


8.17 


1923 


31,793 


253 


7.96 


1924 


33,723 


305 


9.05 


1925 


34 , 840 


297 


8.53 


1926 


36,480 


284 


7.79 


1927 


36,794 


298 


8.10 


1928 


37,056 


316 


8.53 


1929 


38,825 


298 


7.67 


1930 


39,467 


282 


7.14 


1931 


40,565 


305 


7.52 




Deaths from Disease Only, Canal Zone Population (Employees and 

Nonemployees). 
Absolute numbers and rates per 1,000 of population. 







Deaths 


Rate 




Year. 


Popula- 


from dis- 


per 






tion. 


ease only. 


1,000. 




1913 


61 , 700 


890 


14.43 




1914 


46,379 


614 


13.24 




1915 


31,496 


361 


11.30 


HHm 


1916 


31,447 


290 


9.22 


VSBBKM 


1917 


33,044 


273 


8.26 


flMBI 


1918 


33,803 


216 


6.36 


HBH 


1919 


32,366 


207 


8.40 


jfluraai 


1920 


27,459 


211 


7.68 


gnsoi 


1921 


31,377 


211 


6.72 


BBB 


1922 


31,098 


220 


7.08 


msB 


1923 


31,793 


227 


7.14 


SSHB 


1924 


33,723 


270 


8.01 


BENH 


1925 


34,840 


241 


6.92 


MSSBB 


1926 


36,480 


245 


6.72 


IKHMMB 


1927 


36,794 


265 


7.20 


&BBB3 


1928 


37,056 


273 


7.37 




1929 


38,825 


263 


6.77 


HOB 


1930 


39,467 


242 


6.13 


sun 


1931 


40,565 


247 


6.09 


■Si 



13 



There has been gradual reduction in total death rates as well as death 
rates from disease, though the former rose slightly in 1931 over the low 
of 7.14 in 1930. The rate of reduction can best be determined by 
comparing rates during the latter part of the construction period with 
those prevailing during recent years. 

These comparisons by 5-year periods for the Canal Zone are as 
follows: 

CANAL ZONE DEATH RATES BY 5- YEAR PERIODS. 



1912-16. 



1917-21. 



1922-26. 



1927-31. 



Total death rates per 1,000 population 

Death rates from disease per 1,000 population. 



14.54 
12.60 



8.47 
7.07 



8.29 

7.16 



7.78 
6.69 



« 1913-16. 

The progress being made in health conservation is best measured 
by comparing the death rates for disease only. The new factor now 
affecting the population of the Canal Zone is the advancing age of the 
employees, more particularly the colored element. With advancing 
age and greater prevalence of chronic degenerative diseases in this 
group it is doubtful if further material reduction in death rates can 
be attained. It is worthy of note that the death rate for disease only 
for 1931 was the lowest ever recorded in the population of the Canal 
Zone. 

Panama City.— Total death rates and those for disease only are in- 
corporated and presented graphically in the tables following: 
Deaths from all Causes, City of Panama. 
Absolute numbers and rates per 1,000 of population. 







Deaths 


Rate 


Year. 


Popula- 


from all 


per 




tion. 


causes. 


1,000. 


1905 


21,984 


1,447 


65.82 


1906 


25,518 


1,142 


44.75 


1907 


33,548 


1,156 


34.45 


1908 


37,073 


1,292 


34.83 


1909 


40,801 


1,038 


25.44 


1910 


45,591 


1,446 


31.72 


1911 


46,555 


1,456 


31.27 


1912 


47,057 


1,380 


29.33 


1913 


47,172 


1,507 


31.95 


1914 


53,948 


1,863 


34.53 


1915 


60,373 


1,810 


29.98 


1916 


60,778 


1,765 


29.04 


1917 


61,074 


1,714 


28.06 


1918 


61,369 


1,314 


21.41 


1919 


61,369 


1,211 


19.74 


1920 


59,458 


1,297 


21.81 


1921 


61,000 


1,336 


21.90 


1922 


62,500 


1,279 


20.46 


1923 


64,000 


1,106 


17.28 


1924 


65,500 


1,168 


17.83 


1925 


67,000 


1,169 


17.45 


1926 


68,500 


1,188 


17.34 


1927 


70,000 


1,248 


17.83 


1928 


71, .500 


1,434 


20.06 


1929 


73,000 


1,413 


19.36 


1930 


74,402 


1,307 


17.57 


1931 


76,000 


1,341 


17.64 




14 



Deaths from Disease Only, City of Panama. 
Absolute numbers and rates per 1,000 of population. 







Deaths 


Rate 


Year. 


Popula- 


from dis- 


per 




tion. 


ease only. 


1.000. 


1913 


47,172 


1,425 


30.21 


1914 


53.948 


1,772 


32.85 


1915 


60,373 


1,749 


28.97 


1916 


60,778 


1,702 


28.00 


1917 


61,074 


1,661 


27.20 


1918 


61,369 


1,284 


20.92 


1919 


61,369 


1,165 


18.98 


1920 


59,458 


1,246 


20 96 


1921 


61,000 


1,286 


21.08 


1922 


62,500 


1,241 


19.86 


1923 


64,000 


1,078 


16.84 


1924 


65,500 


1,128 


17.22 


1925 


67,000 


1,126 


16.81 


1926 


68,500 


1,152 


16.82 


1927 


70,000 


1,201 


17.16 


1928 


71,500 


1,390 


19.44 


1929 


73,000 


1,370 


18.77 


1930 


74,402 


1,251 


16.81 


1931 


76,000 


1,274 


16.76 




The death rate for disease only for Panama City, in 1931, was the 
lowest for any year of record. Examination of these tables indicates 
that the rates have gradually decreased. The trend downward, 
particularly for disease only, can best be appreciated by considering 
the rates by 5-year periods: 

PANAMA CITY DEATH RATES BY 5-YEAR PERIODS. 



Total death rates per 1,000 population 

Death rates from disease per 1,000 population. 



1912-16. 



30.91 
29.91 



1917-21. 



22.59 
21.83 



1922-26. 



18.05 
17.48 



1927-31. 



18.48 
17.77 



1913-16. 



City of Colon. — The general death rates and those from disease only 
are presented and shown graphically in the tables following: 



15 



Deaths from all Causes, City of Colon. 
Absolute numbers and rates per 1,000 of population. 







Deaths 


Rate 




Year. 


Popula- 


from all 


per 






tion. 


causes. 


1.000. 




1905 
1906 


11,176 
13,651 
14,549 
15,878 
17,479 
19,535 
19,947 
20,174 
20,232 
23,265 
29,331 
24,693 
25,386 
26,078 
26,078 
31,203 


553 
703 
571 
418 
396 
514 
527 
493 
489 
590 
640 
696 
667 
616 
573 
554 


49.48 
51.50 
39.25 
26.32 
22.65 
26.31 
26.42 
24.44 
24.17 
25.36 
21.82 
28.19 
26.27 
23.62 
21.97 
17.75 




1907 
1908 
1909 
1910 
1911 
1912 
1913 
1914 






1915 
1916 
1917 




1918 




1919 
1920 




1921 


31,050 


497 


16.01 




1922 


30,900 


445 


14.40 




1923 


30,750 


393 


12.78 




1924 


30,600 


475 


15.52 




1925 


30,450 


401 


13.17 




1926 


30,300 


452 


14.92 




1927 


30,150 


423 


14.03 




1928 


30,000 


442 


14.73 




1929 


29,850 


492 


16.48 




1930 


29,765 


518 


17.40 




'1931 


30 ,000 


482 


16.07 





Deaths from Disease Only, City of Colon. 
Absolute numbers and rates per 1,000 of population. 



Popula- 
tion. 



20,232 
23,265 
29,331 
24,693 
25,386 
26,078 
26,078 
31,203 
31,050 
30,900 
30,750 
30,600 
30,450 
30,300 
30,150 
30,000 
29 , 850 
29,765 
30 , 000 , 



Deaths 
from dis- 
ease only. 



460 
563 
604 
662 
642 
587 
536 
517 
468 
421 
377 
455 
379 
427 
404 
426 
467 
490 
457 



Rate 

per 

1,000. 




16 



The records indicate a downward trend in both rates until about 
1924, since which time there has been a tendency to increase. The 
general trend can best be shown by comparing the average rates for 
5-year periods: 

COLON DEATH RATES BY 5-YEAR PERIODS. 



1912-16. 



1917-21. 1922-26. 



1927-31. 



Total death rates per 1,000 population ....... 

Death rates from disease per 1,000 population. 



24.71 
23.47 



20.79 
19.67 



14.16 
13.46 



15.74 
14.98 



■ 1913-16. 

The trends for general death rates and death rates for disease only 
were downward between 1911 and 1923, since which time there has 
been an increase. The increase during recent years is probably a seem- 
ing rather than an actual one. The recorded population figures of 
Colon for 1930 show an actual decrease in population since 1921. It 
has been suggested that enumeration of the population was not 
complete during the last census (1930) and that as a matter of fact 
there has been slight but continuous increase in population since 1921. 

BIRTH RATES, CANAL ZONE, PANAMA CITY, AND COLON. 

In analyzing birth rates it is important for many reasons to have 
knowledge not only of the total rate for the new born, but to know 
also the rate of those born alive and of the stillborn. The data neces- 
sary for such tabulation are available since 1916. 



BIRTHS, CANAL ZONE POPULATION (EMPLOYEES AND NONEMPLOYEES). 

ABSOLUTE NUMBERS AND RATES PER 1,000 OF POPULATION. 



Year. 


Population. 


Births. 
(Absolute numbers.) 


Rate per 1,000 population. 


Total. 


Born 
alive. 


Still- 
born. 


Total. 


Born 
alive. 


Still- 
born. 


1916 


31,447 
33,044 
33,803 
32,366 
27,459 
31,377 
31,098 
31.793 
33,723 
34,840 
36,480 
36,794 
37,056 
38,825 
39,467 
40,565 


673 
712 
770 
732 
667 
807 
722 
623 
730 
651 
669 
579 
550 
538 
524 
515 


640 
669 
725 
695 
631 
776 
691 
591 
694 
616 
635 
547 
513 
508 
492 
480 


33 
43 
45 
37 
36 
31 
31 
32 
36 
35 
34 
32 
37 
30 
32 
35 


21.40 
21.55 
22.78 
22.62 
24.29 
25.72 
23.22 
19.60 
21.65 
18.68 
18.34 
15 74 
14.84 
13.85 
13.28 
12.69 


20.35 
20.25 
21.45 
21.47 
22.98 
24.73 
22.22 
18.59 
20.58 
17.68 
17.41 
14.87 
13.84 
13 08 
12.47 
11.83 


1.05 


1917 


1.30 


1918 


1.33 


1919 

1920 


1.14 
1.31 


1921 


.99 


1922 


1.00 


1923 


1.01 


1924 


1.07 


1925 


1.00 


1926 


.93 


1927 


.87 


1928 


1 00 


1929 


.77 


1930 


.81 


1931 


.86 



17 



A cursory examination of this table discloses the fact that there has 
been a striking decrease in birth rates in the Canal Zone since 1916 
which can best be appreciated by comparing the average rates by 
5-year periods: 

CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS. 



1917-21. 



1922-26. 1927-31. 



Total birth rate per 1,000 population 
Live birth rate per 1,000 population . 
Stillbirth rate per 1,000 population. . 



23.33 

22.12 

1.21 



20.22 
19.22 
1.00 



14.04 
13.18 



The marked decrease in total birth rates during recent years is 
attributable in large measure to the following factors: Advancing age 
of the employees who entered service during the construction period ; 
large proportion of generation born in Canal Zone has not yet attained 
maturity and married; and large unmarried group of military popu- 
lation. The crude birth rate for 1931 was the lowest of record. 

That progress is being made in maternity welfare activities is 
evidenced by the fact that the rate for the stillborn is gradually de- 
creasing: 1917-1921, 1.21; 1927-1931, 0.86. 

The population of the Canal Zone is made up of two quite distinct 
elements, (a) white American employees, Army and Navy officers and 
their families, and Army and Navy enlisted personnel, and (b) colored 
alien employees and agriculturists and their families. It is possible 
to examine more in detail the birth rates for these two elements of the 
population. It should be remembered, however, that the large number 
of unmarried enlisted personnel of the Army and Navy (approximate- 
ly 9,300 during 1931) results in an abnormally low birth rate among 
the white population. The rates for the two groups are incorporated 
in the two tables following: 

BIRTHS, CANAL ZONE— WHITE ONLY. 





White 
population. 


Births, 


absolute numbers. 


Rate per 1,000 population. 


Year. 


Total. 


Born 

alive. 


Still- 
born. 


Total. 


Born 
alive. 


Still- 
born. 


1916. 


15,063 
18,108 
18,220 
14,694 
14,224 
16,442 
14,083 
15,483 
16,187 
15,817 
17,036 
16,521 
16,712 
16,967 
16,511 
18,157 


186 
237 
266 
250 
239 
311 
247 
212 
267 
201 
230 
173 
178 
181 
159 
186 


172 
225 
255 
242 
231 
301 
242 
206 
255 
193 
222 
169 
170 
176 
154 
178 


14 

12 

11 

8 

8 

10 

5 

6 

12 

8 

8 

4 

8 

5 

5 

8 


12 35 
13.09 
14.60 
17.01 
16.80 
18 91 
17.54 
13.69 
16.49 
12.71 
13.50 
10.47 
10.65 
10.66 
9.63 
10.24 


11.42 
12.43 
14.00 
16.47 
16.24 
18.30 
17.18 
13.30 
15.75 
12.20 
13.03 
10.23 
10.17 
10.37 
9.33 
9 80 


93 


1917. 


.66 


1918 


.60 


1919 


.54 


1920 


.56 


1921 


.61 


1922 . . 


36 


1923 


.39 


1924 


.74 


1925 


.51 


1926 


47 


1927 


.24 


1928 


.48 


1929 


.29 


1930... 


30 




.44 


MR 31053- — 2 

















18 



BIRTHS, CANAL ZONE— COLORED ONLY. 



Year. 



Colored 
population. 



Births, absolute numbers. 



Total. 



Born 
alive. 



Still- 
born. 



Rate per 1,000 population 



Total. 



Born 
alive. 



Still- 
born. 



1916 
1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 
1925 
1926 
1927 
1928 
1929 
1930 
1931. 



16,384 
14,936 
15,583 
17,672 
13,235 
14,935 
17,015 
16,310 
17,536 
19,023 
19,444 
20,273 
20,344 
21,858 
22,956 
22,408 



487 
475 
504 
482 
428 
496 
475 
411 
463 
450 
439 
406 
372 
357 
365 
329 



468 
444 
470 
453 
400 
475 
449 
385 
439 
423 
413 
378 
343 
332 
338 
302 



29.72 
31.80 
32.34 
27.27 
32.34 
33.21 
27.92 
25 20 
26.40 
23.66 
22.58 
20.03 
18.29 
16.33 
15.90 
14.68 



28.56 
29.73 
30.16 
25.63 
30.22 
31 80 
26.39 
23 61 
25.03 
22.24 
21.24 
18.65 
16.86 
15 19 
14 72 
13.48 



1 16 

2 07 
2.18 

1 64 

2 12 
1.41 
1 53 
1.59 
1.37 
1.42 
1.34 
1 38 
1 43 
1.14 
1 18 
1.20 



It will be noted that since 1924 birth rates have gradually declined 
in both groups of the Canal Zone population. The rate of decline has 
been much greater in the colored population than in the white Ameri- 
can. The low birth rate in the white population as compared with the 
colored is attributable in part to the inclusion in the white population 
of the large group of unmarried military and naval personnel (approxi- 
mately 9,300). The rate of decline in both groups can best be appre- 
ciated by comparing average rates by 5-year periods: 

CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS. BY COLOR. 



1917-21. 



1922-26. 



1927-31. 



White. ! Colored. White. Colored. 



White, i Colored. 



Total birth rate per 1,000 of population 
Live birth rate per 1,000 of population 
Stillbirth rate per 1,000 of population . . 



15.95 
15.35 



31.23 

29.36 

1.87 



14.72 

14.22 

.50 



25.05 

23 61 

1.44 



10.33 

9.98 

.35 



16.96 
15 70 
1.26 



Panama City.— The birth rates for Panama City are incorporated 
in the following table: 



BIRTHS, PANAMA CITY. 

ABSOLUTE NUMBERS AND RATES PER 1,000 OF POPULATION. 



Year. 



1916 
1917 
1918 
1919 
1920 
1921 
1922 
1923 
1924 
1925 
1926 
1927 
1928 
1929 
1930 
1931 



Population. 



60,778 
61,074 
61,369 
61,369 
59,458 
61,000 
62,500 
64,000 
65,500 
67,000 
68,500 
70,000 
71,500 
73,000 
74,402 
76,000 



Births, absolute numbers. 



Total. 



2,598 
2,772 
2,472 
2,359 
2,532 
2,311 
2,162 
2,163 
2,271 
2,339 
2,117 
2,509 
2,578 
2,517 
2,760 



Born, 
alive. 



,371 
.578 
,308 
214 
,376 
173 
058 
043 
144 
220 
003 
380 
458 
302 
626 
4118 



Still- 
born. 



227 
194 
104 
145 
156 
138 
104 
120 
127 
119 
114 
120 
120 
125 
134 
119 



Rate per 1,000 population. 



Total. 



42.75 
45.39 
40.28 
38 44 
42.58 
37.89 
34.59 
33.80 
34.67 
34.91 
30 91 
35.84 
36.06 
34.48 
37.09 
33.25 



Born. 

alive. 



39.01 
42.21 
37.61 
36.08 
39.96 
35.62 
32.93 
31.92 
32.73 
33.13 
29.24 
34.13 
34.38 
32.77 
35.29 
31.68 



Still- 
born. 



3.73- 

3.18 

2.67 

2.36 

2 62 

2.26 

1.66 

1.88 

1 94 

1.78 

1.67 

1 71 

1 68 

1 71 

1.80 

1.57 



19 



The total rates for Panama City have been fairly stationary for the 
past 15 years, with a slight tendency to decrease for the period as a 
whole. Increasingly larger numbers of prospective mothers are now 
admitted to hospital for confinement, and it is estimated that at the 
present time, of all births in Panama City, about 50 per cent are born 
in Santo Tomas Hospital. The midwives, during recent years, have 
been more closely supervised, and during the past two years their work 
has been under the constant supervision of a visiting nurse with special 
training in midwifery. That these measures are beginning to show 
results is evidenced by the downward trend in the stillbirth rates. 
The rate for stillborn during 1931 was the lowest of record. The trend 
of total birth rates, live birth rates, and stillbirth rates is shown in the 
following averages of rates by 5-year periods for the past 15 years: 

PANAMA CITY BIRTH RATES BY 5-YEAR PERIODS. 



1917-21. 



1922-26. 



1927-31. 



Total birth rate per 1,000 population 
Live birth rate per 1,000 population . 
Stillbirth rate per 1,000 population . . 



40.90 

38.28 

2.62 



33.75 

31.97 

1.78 



35.33 

33.64 

1.69 



Colon. — The data concerning birth rates for the city of Colon are 
incorporated in the following table: 



BIRTHS, COLON. 

ABSOLUTE NUMBERS AND RATES PER 1,000 OF POPULATION. 



Year. 



Population. 



Births, absolute numbers. 



Total. 



Born, 
alive. 



Still- 
born. 



Rate per 1,000 population. 



Total. 



Born, 
alive. 



Still- 
born. 



1916. 
1917. 
1918. 
1919. 
1920. 
1921. 
1922. 
1923. 
1924. 
1925. 
1926. 
1927. 
1928. 
1929. 
1930. 
1931. 



24,693 
25,386 
26,078 
26,078 
31,203 
31,050 
30,900 
30,750 
30,600 
30,450 
30,300 
30,150 
30,000 
29,850 
29,765 
30,000 



814 
958 
861 
964 
1,014 
969 
810 
748 
726 
800 
755 
795 
801 
866 
912 
919 



757 
891 
795 
908 
962 
919 
759 
709 
690 
769 
712 
737 
760 
822 
877 
870 



32.96 
35.77 
33.02 
36.97 
32.50 
31.21 
26.21 
24.33 
23.73 
26.27 
24.92 
26.37 
26.70 
29.01 
30.64 
30.63 



30.66 
33.25 
30.49 
34.82 
30.83 
29.60 
24.56 
23.06 
22.55 
25.25 
23.50 
24.44 
25.33 
27.54 
29.46 
29.00 



2.31 
2.52 
2.53 
2.15 
1.67 
1.61 
1.65 
1.27 
1.18 
1.02 
1.42 
1.92 
1.37 
1.48 
1.18 
1.63 



The general trend in birth rates for Colon since 1917 has been a 
declining one though not so noticeable as for Panama City. Consider- 
ing the rate by 5-year periods for the past 15 years, the averages for 
each period are as follows: 



Total birth rate per 1,000 population . 
Live birth rate per 1,000 population 
Stillbirth rate per 1,000 population . . 



1917-21. 



34.09 

32.01 

2.08 



1922-26. 



25.09 

23.78 

1.31 



1927-31. 



28.66 

27.15 

1.51 



20 



The increase in birth rates for the last 5 years is probably a seeming 
rather than actual one attributable in all probability to error in 
population figures. 

INFANT MORTALITY RATES, CANAL ZONE, PANAMA CITY, 

AND COLON. 



Records of infant mortality for the three groups of population con- 
cerned, Canal Zone, Panama City, and Colon, have been compiled 
since 1916 and the data are presented in the following table: 

INFANT MORTALITY, CANAL ZONE, PANAMA CITY, AND COLON. 
(Deaths of children under one year of age.) 

ABSOLUTE NUMBERS AND RATES PER 1,000 OF LIVE BIRTHS. 











Canal Zone. 








Panama. 




Colon. 






Live births. 
Absolute 
numbers. 






Deaths. 




Live 
births. 


Deaths. 


Live 
births. 




Y>-:ir. 


American 

(white). 


Foreign 
(colored). 


Total. 


Deaths. 




a 


ft 


o 


3-C 

"3 E 
< ~ 


o 
o 

1 


■ie 

i i 


o 
o 

o_ 

a 

« 


■3 S 

3 I 


8 

o 

p, 

(3 


Absolute 
numbers. 


■3 £ 

J 3 


s 


Absolute 
numbers. 


Absolute 

numbers. 

Rate per 1,000. 


1916 


172 
225 
255 
242 
231 
301 
242 
206 
255 
193 
222 
169 
170 
176 
154 
178 


468 
444 
470 
453 
400 
475 
449 
385 
439 
423 
413 
378 
343 
332 
338 
302 


640 
669 
725 
695 
631 
776 
691 
591 
694 
616 
635 
547 
513 
508 
492 
480 


7 
4 
5 
9 
8 

10 

10 
9 

12 
7 

13 
5 

16 

8 
8 
5 


42 
18 
20 
37 
34 
33 
41 
44 
47 
36 
59 
30 
94 
45 
52 
28 


70 
80 
55 
70 
52 
65 
54 
34 
55 
41 
44 
54 
43 
40 
32 
29 


149 
180 
117 
155 
130 
137 
120 

88 
125 

97 
107 
143 
125 
120 

95 

96 


77 
84 
60 
79 
60 
75 
64 
43 
67 
48 
57 
59 
59 
48 
40 
34 


120 
126 
83 
114 
95 
97 
93 
73 
97 
78 
90 
108 
115 
94 
81 
71 


2,371 
2,578 
2,308 
2,214 
2,376 
2,173 
2,058 
2,043 
2,144 
2,220 
2,003 
2,389 
2,458 
2.392 
2,626 
2.408 


616 
668 
414 
342 
369 
378 
303 
290 
296 
260 
289 
287 
364 
339 
319 
342 


260 
259 
180 
154 
155 
174 
147 
142 
138 
117 
144 
120 
148 
142 
121 
142 


757 
891 
795 
908 
962 
919 
759 
709 
690 
769 
712 
737 
760 
S22 
877 
870 


185 244 


1917 


222 24S 


1918 


156 107 


1919 


141 
137 
128 
106 
82 
79 


155 


1920 


14? 


1921 


139 


1922 


140 


1923 


116 


1924 


115 


1925 

1926 

1927 


90 117 
92 129 
80 109 


1928 


79 104 


1929 


95 
95 
95 


116 


1930 

1931 


108 
109 



The better to visualize any results being obtained in the reduction of 
infant mortality rates in the three groups of the population concerned, 
the average rates for each group by 5-year periods 1917-1921, 1922- 
1926, and 1927-1931, are tabulated below: 

INFANT MORTALITY RATES FOR 5-YEAR PERIODS, CANAL ZONK AND ITTIKS 
OF PANAMA AND COLON. 



Period. 




Canal Zone 




Panama. 


Colon. 




White. 


Colored. 


Total. 




I'll 7 21 


28.71 
45 62 
50.77 


143.62 
108.11 
116.95 


102.40 
86.46 

94 49 


186.37 
137.37 
134.52 


175.20 


1922-26 


123.39 


1927 31 


109.20 







21 



Canal Zone. — Infant mortality rates in the white American popula- 
tion of the Canal Zone have been quite satisfactory, ranging between 
18 and 59 per 1,000 live births for the years 1917 to 1931 inclusive, 
except for 1928 when the rate was 94. For the colored population the 
variation during the sanie period has been between 88 and 180. The 
infant mortality rates in this group were considerably in excess of 100 
(107 to 143) during the years 1926 to 1929 inclusive, and for 1931 they 
still were 96. Efforts are being made to lower these rates through a 
visiting nurse service. As a result of a low rate in the white American 
population (28) the general infant mortality rate for the Canal Zone 
for 1931 was the lowest of record (71). 

Panama City. — Considerable progress has been made since 1917 in 
reducing infant mortality rates in Panama City. The rates for the 
5-year period 1917-1921 average 186 per 1,000 live births, whereas for 
the period 1927-1931 they had been reduced to 135. 

Colon. — Excellent progress has been made in reducing the infant 
mortality rates in Colon. For the 5-year period 1917-1921 the rate 
averaged 175, whereas for the period 1927-1931 it had been reduced 
to 109. 

PRINCIPAL CAUSES OF DEATH, CANAL ZONE, 
PANAMA CITY, AND COLON. 

It has been customary in the Health Department annual reports of 
recent years to report the six principal causes of death from disease 
in Panama Canal employees and in the populations of the cities of 
Panama and Colon. Commencing with last year's report, comparable 
data for the entire population of the Canal Zone have been included. 
The statistics for the past five years for the three population groups 
involved, Canal Zone, Panama City, and Colon, are being included in 
this report. Comparable rates for Panama Canal employees are in- 
cluded in a subsequent section. 

Principal causes of death, Canal Zone population. — The data on this 
subject are incorporated in the following table: 

SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, CANAL ZONE POPULATION, 1927-1931. 

ABSOLUTE NUMBERS AND RATES PER 1,000. 



Population . 



Disease . 



Pneumonia (broncho and lobar) 
Tuberculosis (various organs) . . . 

Syphilis 

Organic diseases of the heart. . . 
Nephritis (acute and chronic) . . 
Oancer (various organs) ........ 

Diseases of the arteries 



1927. 



36,794 



Num- 
ber. 

24 
18 
18 
17 
16 
13 



Rate 

per 

1,000. 

.652 
.489 
.489 
.462 
.435 
.353 



1928. 



37,056 



Num- 
ber. 

36 
25 
11 
11 
19 
16 



Rate 
per 
1,000. 

.972 
.674 
.297 
.297 
.513 
.432 



1929. 



38,825 



Num- 
ber. 

27 
34 
11 
15 
23 
16 



Rate 
per 
1,000. 

.695 
.876 
.283 
386 
.592 
.412 



1930. 



39,467 



Num- 
ber. 

30 
20 
10 
22 
21 
15 



Rate 

per 

1,000. 

.785 
.507 
.253 
.557 
.532 
.405 



1931. 



40,565 



Num- 
ber. 

23 

19 
11 

" 18 
15 
II 



Rate 

per 
1,000. 

.567 
.468 
.271 

"!444 
.370 
.271 



22 



Tuberculosis and pneumonia usually take the greatest toll of life in 
the population of the Canal Zone; diseases of the chronic degenerative 
type such as nephritis, cancer, and organic disease of the heart are 
being noted with greater frequency as the principal cause of death, 
although deaths from heart disease declined to' nine in 1931. Tubercu- 
losis and the pneumonias affect the colored populations to a far 
greater extent than the white. For the current year the death rates 
from these two diseases ranged slightly lower than for any year during 
the past four years. 

Principal causes of death, Panama City. — The six principal causes of 
death in the population of Panama City for the past five years are 
shown in the following table: 

SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, PANAMA CITY, 1927-1931. 

ABSOLUTE NUMBERS AND RATES PER 1,000. 



Population . 



Disease. 



Pneumonia (broncho and lobar) 

Tuberculosis (various organs) 

Diarrhea and enteritis, including colitis. 

Organic diseases of the heart 

Nephritis (acute and chronic) 

Cancer (various organs) 

Syphilis 



1927. 



70,000 



Num- 
ber. 



187 
180 
122 
112 
105 
56 



Rate 

per 

1,000. 



1928. 



Num- 
ber. 



2.67 
2.57 
1.74 
1.60 
1.50 



Rate 

per 

1,000. 



248 3 47 
227 3.17 



117 
105 
115 



4S 



1.64 
1.47 
1.61 



.67 



1929. 



73,000 



Num- 
ber. 



231 
204 
148 
118 
114 
67 



Rate 

per 

1,000. 



3.16 
2.79 
2.03 
1.62 
1.56 
.92 



1930. 



1931. 



74,402 



Num- 
ber. 



180 
208 
98 
98 
113 
59 



Rate 

per 

1,000. 



2.42 
2.80 
1.32 
1.32 
1.52 
.79 



Num- 
per. 



76,000 

I Rate 

per 

1,000. 



202 
218 
135 
137 
64 
62 



1.78 

1.80 

.84 

82 



As is the case with the population of the Canal Zone, tuberculosis 
and the pneumonias are the leading causes of death. Death rates from 
these two diseases are much higher in Panama City than in the popu- 
lation of the Canal Zone. The death rates from tuberculosis in the 
Canal Zone ranged between 0.47 and 0.88 per 1,000 population for the 
years 1927-1931, whereas comparable rates in Panama City ranged 
between 2.57 and 3.17. The differences in rates are attributable in 
large measure to housing conditions in Panama City and the economic 
status of the populations affected. 

A similar disparity will be noted between death rates from the pneu- 
monias in Panama City and the Canal Zone. The very high rates in 
Panama City as compared with the Canal Zone are attributable to 
the factors cited in the case of deaths from tuberculosis. 

Principal causes of death, Colon. — The six principal causes of death 
in the population of Colon, for the years 1927 to 1931, are shown in 
the following table: 



23 



SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, COLON, 1927-1931. 

ABSOLUTE NUMBERS AND RATES PER 1,000. 



Population . 



Tuberculosis (various organs) 

Pneumonia (broncho and lobar) 

Nephritis (acute and chronic) 

Diarrhea and enteritis, including colitis. 

Cancer (various organs) 

Organic diseases of the heart 

Apoplexy 

Syphilis 



1927. 



30,150 



Num- 
ber. 



Rate 

per 

1,000. 



2.65 

1.29 

1.23 

.90 

.86 

.73 



1928. 



Num- 
ber. 



Rate 

per 

1,000. 



1929. 



29,850 



Num- 
ber. 



Rate 
per 
1,000. 



2.14 
2.11 
1.01 
1.04 



.94 
.94 



Num- 
ber. 



29,765 

Rate 

per 

1,000. 



2.39 
1.65 
1.38 
1.14 



1931. 



30,000 



Num- 
ber. 



Rate 

per 

1,000. 



3.00 

1.70 

.80 

.87 



1.87 

.77 



It will be noted as was the case in the other groups of the population 
of the Isthmus, that the leading causes of death are tuberculosis and 
the pneumonias. 

The most interesting point to be noted is that the death rates from 
both tuberculosis and the pneumonias are very materially lower in 
Colon than in Panama City, the higher rate for tuberculosis in Colon 
in 1931 being an exception. The average rates per 1,000 population 
per annum for the 5-year period 1927-1931 are as follows: 

AVERAGE DEATH RATES PER 1,000 POPULATION PER ANNUM FOR 5- YEAR PERIODS, 1922-1926, 
AND 1927-1931, FROM PNEUMONIAS AND TUBERCULOSIS. 





Panama. 


Colon. 


Pneumonias, 1922-1926 


2.89 
2.87 


1.38 


Pneumonias, 1927-1931 


1.80 






Tuberculosis, 1922-1926 

Tuberculosis, 1927-1931 


3.14 

2.84 


2.37 
2.46 



The factors probably responsible for this discrepancy are not known. 
On the average, housing conditions in Colon are better than in Panama 
City. The rates for Panama City are artificially high due to the fact 
that the principal Panamanian Government hospital (Santo Tomas) 
is located in Panama City and patients treated in that hospital who 
actually reside in the provincial districts not infrequently give a 
Panama City address as their place of residence. 

ACUTE TRANSMISSIBLE DISEASES REPORTED IN 1931. 



Beginning with the annual report of 1929, a table was introduced 
showing the number of cases of transmissible diseases reported to the 
Health Department of the Panama Canal The reports for the Canal 
Zone are quite complete, but for Panama City and Colon they are not 



24 



so complete, especially for the less serious diseases such as whooping 
cough, mumps, etc. The cases reported during 1931 are incorporated 
in the following table: 

CONTAGIOUS AND INFECTIOUS DISEASES, CASES AND DEATHS, REPORTED TO THE 
CHIEF HEALTH OFFICER DURING THE YEAR 193E 





Reported place of infection. 


Disease. 


Panama. 


Colon. 


Canal Zone. 


Outside the 
Zone and termi- 
nal citioi. 


Total. 




New 

cases. 


Deaths. 


New 
cases. 


Deaths. 


New 
cases. 


Deaths. 


New 
cases. 


Deaths. 


New 

cases. 


Deaths. 


Chicken pox. ....... 

Diphtheria 

Dysentery, amebic. . 
Dysentery, bacillary 


81 
57 
18 

1 
234 

372 

1 
4 

(') 


1 
3 

1 
6 

1 


24 
20 
4 

1 
62 
45 

2 


1 
2 

I 

1 


53 

7 
2 




16 
32 
24 

1 

58H 

28 

3 
1 
(') 
1 


2 

1 
23 

52 


174 
116 

48 

3 

2,117 
488 

9 

(') ' 

2 

1 

20 


3 
3 

3 




1 . 236 

43 

3 

•> 

(') 


13 

1 
23 


44 


Measles 

Meningitis, menin- 
gococcus 


2 
2 


Pneumonia 


202 


C) 

1 


51 


328 










1 

7 






Scarlet fever 


2 




10 






1 






Tuberculosis 

Typhoid fever 


3 


218 


(') 
5 


90 


C) 
1 


19 

1 


8 


45 


17 


878 

1 


Whooping cough . . 

Maritime quaran- 
tinable diseases. 


26 


3 


55 


1 


40 




12 


1 


133 


5 




1 


2 


2 


1 






O 


5 


8 


8 
























2 




2 




















Tvphus fever 


"2 
















»2 





















■ As many cases of pneumonia and tuberculosis are not reported unless death occurs, this report shows only the 
number of deaths from these two diseases. 

■ Sporadic cases which in some respects resembled clinically mild typhus as it occurs in the United Sutes (Brill's 
disease), giving positive Weil-Felix reaction. 

This table gives one a definite conception of the types of trans- 
missible diseases that are most commonly encountered in this region. 
In general terms the data show the following facts so far as the popu- 
lations of the Canal Zone, Panama City, and Colon are concerned. 

The so-called intestinal group of diseases (typhoid and para-typhoid 
fevers and the dysenteries) are of rare occurrence. The fatality rate 
in diphtheria is very low. While measles is of not uncommon occur- 
rence it is but seldom complicated by pneumonias and the fatality 
rate is low. Scarlet fever and meningococcus meningitis but rarely 
occur and usually a considerable proportion of the few cases of men- 
ingitis occur in military personnel, the disease having been contracted 
in the United States (recruits en route to foreign service). In cities 
so closely surrounded by a large rural population heavily infected 
with malaria the difficulties in deciding as to the place of infection 
with malaria parasites are obvious. Pneumonia and tuberculosis are 
very common, with high fatality rates. 



25 
VITAL STATISTICS, PANAMA CANAL EMPLOYEES. 

Statistics covering this particular group of the population are quite 
complete. Force reports showing total number of employees are con- 
stantly available, and when time is lost on account of illness record is 
made of that fact. Reports of diagnosis of cases in quarters on account 
of convalescence after hospitalization or on account of minor com- 
plaints, ordinarily are not recorded in morbidity reports, except in 
the case of malaria. Malaria constitutes the most important cause 
of noneffectiveness in employees and all clinical cases requiring treat- 
ment by a physician (hospital or quarters) are made the subject of a 
special report and included in the statistics on malaria, and in data 
relating to admission rates to hospitals and quarters and noneffective 
rates. 

In August, 1930, a new policy was put into effect that should have 
a tendency to reduce the malaria rates among employees. In large 
construction projects in nonsanitated areas, much of the labor is 
drawn from nearby villages — sometimes as high as 50 per cent — and 
a considerable number of the laborers from such sources are carriers of 
the malarial parasite but have no clinical symptoms. Formerly, not 
until these laborers became ill, and upon being sent to the District 
physician were found to have malaria, did they receive treatment for 
malaria. In August, 1930, the policy was adopted of making routine 
monthly blood surveys of laborers engaged on such projects, and 
administering quinine regularly to those found to be positive, irrespec- 
tive of the fact that they had jio clinical symptoms. It can be 
assumed that a certain proportion (just what proportion we do not 
venture to estimate) of the individuals so treated would, if not so 
treated, come down with subjective and objective symptoms of ma- 
laria at one time or another. The individuals found positive for 
malaria in this group, practically all of whom are residents of native 
villages and employed temporarily by the Panama Canal, are not 
included in the Health Department malaria statistics unless they 
become ill and lose time from their work on account of malaria. The 
routine survey and treatment of this group should tend to bring 
about a slight reduction in general malaria rates in employees. 

It should also be pointed out that statistics relating to employees 
are not representative of a homogeneous geographical group of the 
population. The American white employees of the Canal reside in the 
Canal Zone under hygienic and environmental conditions that are quite 
satisfactory. The Panama Canal, however, employs approximately 
11,000 colored alien individuals onlv about one-third of whom live 



26 



in the Canal Zone, the remainder, with their families, living in Panama 
City, Colon, and elsewhere, under much less favorable hygienic 
conditions. 

In the interpretation of statistics relating to employees, it is therefore 
necessary to give consideration to the factors outlined above, as well 
as to those mentioned in this report in the introductory paragraphs on 
vital statistics for the Isthmus of Panama. (See page 10 of this report 
and page 12 of the annual report for 1930.) 

EMPLOYEES, GENERAL DEATH RATES, ALL CAUSES. 



Death rates among employees from all causes for the period 1906 to 
1931 are incorporated in the following table: 

Employees, Deaths from all Causes. 
Absolute numbers and rates per 1,000 employees. 





Average 


Number 


Rate 


Year. 


number 


of 


per 




employed. 


deaths. 


1.000. 


1906 


26,547 


1,105 


41.70 


1907 


39,238 


1,132 


28.85 


1908 


43,890 


571 


13.01 


1909 


47,167 


502 


10.64 


1910 


50 , 802 


558 


10.98 


1911 


48,876 


539 


11.02 


1912 


50,893 


467 


9.18 


1913 


56,654 


473 


8.35 


1914 


44,329 


312 


7.04 


1915 


34,785 


201 


5.77 


1916 


33,176 


200 


6.03 


1917 


32,589 


231 


7.09 


1918 


25,520 


207 


8.11 


1919 


24 , 204 


175 


7.23 


1920 


20,673 


180 


8.70 


1921 


14,389 


93 


6.46 


1922 


10,447 


72 


6.89 


1923 


10,976 


73 


6.65 


1924 


11,625 


84 


7.23 


1925 


12,180 


109 


8.95 


1926 


12,732 


115 


9.03 


1927 


13,561 


122 


9.00 


1928 


14,260 


142 


9.96 


1929 


16,193 


168 


10.37 


1930 


15,524 


180 


11.59 


1931 


14,597 


133 


9.11 




Since 1921, the general tendency has been for death rates for em- 
ployees to increase, though the rate for 1931 was an exception. The 
rates during the early construction period were high (1906-1910, 18.63). 
After completion of the Canal when the population became stabilized 
and the employees were still comparatively young, the death rates 
attained their lowest ebb (1921-1925, 7.23). 



27 



During recent years the average age of this group has gradually in- 
creased, a larger proportion of individuals are becoming disabled with 
and dying as the result of diseases of the so-called chronic degenerative 
type, and the general death rates are gradually increasing (1927-1931, 
10.05). 

EMPLOYEES, DEATH RATES, DISEASE ONLY. 

Death rates from disease only for all Panama Canal employees and 
the racial distribution of these rates (white and colored) are incorpo- 
rated in the following table: 

EMPLOYEES, DEATHS FROM DISEASE ONLY. 

ABSOLUTE NUMBERS AND RATES PER 1,000, WHITE, COLORED, AND TOTAL. 



Year. 


Number of employees. 


Number of deaths from 
disease only. 


Death rate per 1,000, 
disease only. 




White. 


Colored. 


Total. 


White. 


Colored. 


Total. 


White. 


Colored. 


Total. 


1906 


5,106 
10,604 
12,383 
11,662 
13,021 
12,251 
12,553 
11,943 
7,024 
4,719 
4,552 
4,814 
4,408 
4,523 
4,688 
3,855 
2,827 
2,846 
3,055 
3,123 
3,121 
3,197 
3,308 
3,505 
3,589 
3,551 


21,441 
28,634 
31,507 
35,505 
37,781 
36,625 
38,340 
44,711 
37,305 
30,066 
28,624 
27,775 
21,112 
19,681 
15,985 
10,534 
7,620 
8,130 
8,570 
9,057 
9,611 
10,364 
10,952 
12,688 
11,935 
11,046 


26,547 
39,238 
43,890 
47,167 
50,802 
48,876 
50,893 
56,654 
44,329 
34,785 
33,176 
32,589 
25,520 
24,204 
20,673 
14,389 
10,447 
10,976 
11,625 
12,180 
12,732 
13,561 
14,260 
16,193 
15,524 
14,597 


'19 
97 
90 
75 
64 
72 
58 
43 
47 
15 
15 
22 
16 

8 
17 
10 
10 
15 
13 

9 
18 
19 
19 
23 
27 
21 


1,024 
848 
291 
281 
317 
302 
266 
254 
265 
126 
137 
165 
166 
142 
136 
72 
54 
52 
51 
85 
77 
87 
112 
128 
148 
96 


1,043 

945 

381 

356 

381 

374 

324 

297 

312 

141 

152 

187 

182 

150 

153 

82 

64 

67 

64 

94 

95 

106 

131 

151 

175 

117 


3.72 
9.15 
7.27 
6.43 
4.92 
5.88 
4.62 
3.60 
6.69 
3.18 
3.29 
4.57 
3.63 
1.77 
3.63 
2.59 
3.54 
5.27 
4.26 
2.88 
5.77 
5.94 
5.74 
6.56 
7.52 
5.91 


47.76 
29.62 
9.24 
7.91 
8.39 
8.25 
6.94 
5.68 
7.10 
4.19 
4.79 
5.94 
7.86 
7.21 
8.51 
6.83 
7.09 
6.40 
5.95 
9.39 
8.01 
8.39 
10.23 
10.09 
12.40 
8.60 


39.29 


1907 

1908 

1909 


24.08 
8.68 
7.55 


1910 


7.50 


1911 


7.65 


1912 


6.37 


1913 


5.24 


1914 


7.04 


1915 


4.05 


1916 


4.58 


1917 


5.74 


1918 


7.13 


1919 


6.20 


1920 


7.40 


1921 


5.70 


1922 


6.13 


1923 


6.10 


1924 


5.51 


1925 


7.72 


1926 


7.46 


1927 


7.82 


1928 


9.19 


1929 


9.33 


1930 

1931 


11.27 
8.02 


■ Americans only. 





















The death rates were the lowest of record for the past three years in 
whites, and for the past four years in colored. 

The above table discloses an interesting point. During the 26-year 
period, death rates of white employees were lower than colored without 
an exception, and considerably lower in a number of years. This 
difference in death rates is further emphasized by comparing the rates 
by race, for 5-year periods, as follows: 



White employees . . 
Colored employees. 



1908-1912. 



5.8 
8.1 



1917-1921. 



3.28 
7.16 



1922-1926. 



4.34 

7.42 



1927-1931. 



6.36 
10.02 



28 

The death rates in colored employees range from 40 per cent to 
118 per cent higher than those in white employees. The comparatively 
low rates in white employees are attributable to many factors favorable 
to such employees, among which may be mentioned: Rates of pay, 
scale of living, physicial stamina, intelligence, education, and hygiene 
and sanitation in the home and immediate environment. Another 
important factor is that while in both racial groups the average age has 
gradually increased to such an extent that diseases of the so-called 
chronic degenerative type are becoming more common, they are 
affecting the colored employees proportionately to a greater degree 
than white employees, and increasingly larger numbers of colored em- 
ployees are dying of such diseases while still in active service. 

It is to be noted that in recent years death rates in both groups of 
employees are attaining higher levels, although the 1931 rates are a 
notable exception. The diseases which usually cause the highest 
mortality were much less fatal in 1931 than the preceding year. Death 
rates for heart disease declined 63 per cent ; for tuberculosis, 40 per cent ; 
for nephritis, 38 per cent; and for cancer, 35 per cent. 

ADMISSIONS OF EMPLOYEES TO HOSPITALS AND 

QUARTERS. 

The basic data from which admission to hospitals and quarters are 
compiled and the types of cases included are explained in the general 
discussion of vital statistics for Panama Canal employees appearing on 
page 12 of the annual report for 1930. 

The annual rates for the period 1906-1931 are shown in the following 
table: 



29 



Employees, Admissions to Hospitals and Quarters from all Causes. 
Rates per 1,000 employees. 





Average 


Rate 


N ear. 


number 


per 




employed. 


1.000. 


1906 


26,547 


1,779 


1907 


39,238 


1,419 


1908 


43 , 890 


1,132 


1909 


47,167 


887 


1910 


50,802 


905 


1911 


48,876 


896 


1912 


50,893 


727 


1913 


56.654 


519 


1914 


44,329 


420 


1915 


34,785 


320 


1916 


33,176 


283 


1917 


32,589 


357 


1918 


25,520 


406 


1919 


24,204 


550 


1920 


20,673 


672 


1921 


14,389 


620 


1922 


10,447 


490 


1923 


10,976 


485 


1924 


11,625 


513 


1925 


12,180 


519 


1926 


12,732 


474 


1927 


13,561 


502 


1928 


14 , 260 


595 


1929 


16,193 


602 


1930 


15,524 


603 


1931 


14,597 


705 





The average age of both white and colored employees is gradually- 
increasing and, as is to be anticipated under such conditions, the 
admission rate to hospitals and quarters has increased slightly from 
year to year during the past six years. The admission rate increased 
markedly during 1931 and is the highest since 1912. 

The admission rate per 1,000 to hospitals for disease by race (white 
and colored) has been as follows for the past five years: 

ADMISSION RATE PER 1,000 EMPLOYEES, BY RACE (WHITE AND COLORED). 



Year. 


White. 


Colored. 


1927 


209 
240 
273 
288 
310 


95 


1928 


128 


1929 


154 


1930 


180 


1931 


187 







PRINCIPAL CAUSES OF ADMISSION OF EMPLOYEES 
TO HOSPITALS. 

The six diseases causing the greatest number of admissions of em- 
ployees to hospitals during the past five years are incorporated in 
the following table: 



30 



EMPLOYEES, PRINCIPAL CAUSES OF ADMISSION TO HOSPITALS. 





1927. 


1928. 


1929 


1930. 


1931. 




Total. 


Rate 
1,000. 


Total. 


Rate 
1,000. 


Total. 


Rate 
1,000. 


Total. 


Rate 
1,000. 


Total. 


Rate 
1,000. 


Malaria (including the few cases treated 


145 
127 


11 
9 


203 
121 
49 
103 
94 
70 


14 
8 
4 

7 
7 
5 


337 
184 
153 
113 
121 


21 
11 
9 
7 
7 


410 
136 


26 
9 


276 
153 
270 
131 
106 
114 


19 




10 




19 




84 
66 
57 


6 
5 

4 






9 




130 
150 
113 


8 
10 

7 


7 




g 












41 


3 




















109 


7 


106 


7 





















NONEFFECTIVE RATES, ALL CAUSES, EMPLOYEES. 

These rates are shown in table below: 

Noneffective Rates from all Causes, Employees. 
Rates per 1,000. 



Year. 


Average 

number 

employed. 


Rate 

per 

1,000. 




1906 
1907 
1908 
1909 


26,547 
39,238 
43,890 
47,167 
50,802 
48,876 
50,893 
56,654 
44,329 
34 , 785 
33,176 
32,589 
25,520 
24,204 
20,673 
14,389 
10,447 
10,976 
11,625 
12,180 
12,732 
13,561 
14,260 
16,193 
15,524 
14.597 


28.48 
25.09 
22.31 
21.93 
24.37 
24.46 
21.11 
15.97 
12.22 
10.28 
9.20 
9.65 
11.19 
14.29 
14.87 
13.96 
14.81 
13.78 
13.51 
13.77 
12.08 
13.81 
14.66 
15.23 
14.90 
15.45 




1910 
1911 
1912 
1913 
1914 
1915 
1916 
1917 
1918 




1919 
1920 
1921 




1922 
1923 
1924 




1925 
1926 
1927 




1928 
1929 
1930 




1931 





Noneffective rates apparently have become stabilized though in- 
creases have occurred during the past five years over the preceding 
five years (average 1922-1926, 13.53; 1927-1931, 14.90). 



31 

ADMISSION RATES, MALARIA, HOSPITAL AND QUARTERS, 

EMPLOYEES. 



Malaria is the most important disease prevention problem in which 
the Health Department is engaged. Every effort is made to diagnose 
and report in morbidity statistics all clinical cases seen by Panama 
Canal physicians. Statistical records of cases of malaria occurring 
in employees are the most accurate and complete that are compiled 
for any special group of the population residing on the Canal Zone, 
except military personnel, as employees absent from duty must secure 
a certificate from a physician to cover absence on account of illness in 
order to be paid for time lost. 

The admission rates per 1,000 per annum for all employees for the 
years 1906 to 1931 inclusive, are incorporated in the following table: 

Malaria Cases, Employees Only. 
Absolute numbers and rates per 1,000 employees. 





Average 


Number 


Rate 






Year. 


number 


of 


per 








employed. 


cases. 


1,000. 






1906 


26,547 


21,795 


821 




1907 
1908 


39,238 
43 , 890 


16,637 
12,372 


424 

282 






1909 


47,167 


10,169 


215 


^■■■■IH 




1910 


50,802 


9,487 


187 






1911 


48,876 


8,987 


184 






1912 


50,893 


5,623 


110 






1913 


56,654 


4,284 


76 






1914 


44,329 


3,635 


82 






1915 


34,785 


1,781 


51 






1916 


33,176 


547 


16 


1 




1917 


32,589 


473 


14 


1 




1918 


25,520 


472 


18 


1 




1919 


24,204 


752 


31 


■ 




1920 


20,673 


401 


19 


1 




1921 


14,389 


214 


15 


1 




1922 


10,447 


176 


17 


1 




1923 


10,976 


212 


19 


1 




1924 


11,625 


190 


16 


1 




1925 


12,180 


330 


27 


■ 




1926 


12,732 


179 


14 


1 




1927 


13,561 


145 


11 


1 




1928 


14,260 


203 


14 


1 




1929 


16,193 


337 


21 


1 




1930 


15,524 


410 


26 


■ 




1931 


14,597 


276 


19 ■ 





When malaria control measures (drainage, oiling, screening, etc.) on 
a large scale are first carried out in heavily infected areas in various 
parts of the world the initial reduction in malaria is spectacular. Such 
a reduction -occurred in employees of the Panama Canal during the 



32 

construction period when the malaria rates were gradually reduced from 
821 cases per 1,000 in 1906 to 76 in 1913. After the opening of the 
Canal for traffic in 1914, the population became stabilized and between 
1916 and 1931 the annual rates per 1,000 has ranged between 11 and 31. 
It may be said that the rate of malaria in employees under normal con- 
ditions, when large field projects are not being undertaken in nonsani- 
tated areas, ranges from about 14 to 19 cases per 1,000 of employees 
each year. 

The relatively high malaria rates prevailing in 1925, 1929, and 1930 
were due to the fact that large construction projects were under way 
beyond the areas in which permanent drainage and other malaria 
control measures are undertaken as a matter of routine. (See pages 
35 and 36 Annual Report 1930.) During 1931, the principal construction 
projects in which Panama Canal forces were engaged, beyond the 
limits of the so-called sanitated areas, were a continuation of work in 
the Madden Dam area and construction of the Thatcher Highway on 
the west side of the Canal. 

The usual malaria control measures instituted in temporary con- 
struction projects beyond the permanently sanitated areas are: Screen- 
ing of all buildings to be occupied by human beings, elimination of 
mosquito breeding in the immediate vicinity of the camps, the capture 
of adult mosquitoes inside screened buildings every morning, hospitali- 
zation of individuals with malaria, and the provision of ample, varied 
and nutritious food for laborers. 

During part of the year 1930, and in 1931 for the entire year, there 
were added to the control measures mentioned above monthly blood 
surveys of all individuals engaged on projects of this nature and the 
treatment of those found to be carriers of malarial parasites. 

There was marked reduction in malaria rates in employees in 1931 — 
19 per 1,000 as compared with 26 per 1,000 in 1930. The malaria 
season for the year 1930 was one of the worst experienced for a num- 
ber of years on the Isthmus and in the Republic of Panama, whereas 
the 1931 malaria season was of the type usually encountered. 

The rate for 1931 (19) was appreciably lower than the comparable 
rate for 1929 (21) notwithstanding that large field projects were undef 
way during both years. 

. It is probable that the monthly surveys, with treatment of indi- 
viduals harboring parasites in the blood but without symptoms, were 
factors of importance. 

Extensive field projects were under way during the years 1925, 1929, 
1930, and 1931. Excluding the malaria occurring in individuals en- 
gaged in such field projects, the rates of these years would be: 1925, 17; 



33 

1929, 14; 1930, 19; 1931, 16. That substantial progress is being main- 
tained in reducing the prevalence of malaria among employees, is evi- 
dent when we exclude from consideration the cases chargeable to 
field projects in nonsanitated areas. On this basis, the average annual 
rate per 1,000 employees for the 5-year period 1922-1926 was 17; 
whereas for the 5-year period 1927-1931, it had declined to 15. 

The lowest rate so far attained in Canal Zone employees was that of 
11 per 1,000 in 1927. 



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34 



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35 



The interesting point shown in the racial distribution of malaria in 
Panama Canal employees is the fact that admission rates per 1,000 
were much higher in white employees than in colored during the period 
of construction of the Canal (1906-1914) and in fact until 1917, since 
which time the rates in both races have tended to be equal. This 
finding (high rates in white Americans during the construction period) 
supports other epidemiological evidence which suggests strongly that 
the inhabitants of tropical countries in which malaria has been of 
common occurrence for centuries, gradually have acquired a tolerance 
or immunity to the disease and that it is the new arrival from non- 
malarial countries who, suffers most severely. 



DEATH RATES, MALARIA, EMPLOYEES. 

The death rates from malaria, Panama Canal employees, are shown 
in the following table: 





Deaths from Malaria Among Employees Only. 


Absolute numbers and rates per 1,000 employees. 




Average 


Number 


Rate 




Year. 


number 


of 


per 






employed. 


deaths. 


1,000. 




1906 


26,547 
39,238 
43,890 


233 

154 

73 


8.78 
3.92 
1.66 




1907 
1908 




1909 


47,167 


52 


1.10 




1910 


50,802 


50 


.98 




1911 


48,876 


47 


.96 




1912 


50,893 


20 


.39 




1913 


56,654 


21 


.37 




1914 


44,329 


7 


.16 


1 


1915 


34,785 


8 


.23 


1 


1916 


33,176 


2 


.06 


1 


1917 


32,589 


3 


.09 


1 


1918 


25,520 


2 


.08 ' 


I 


1919 


24 , 204 


2 


.08 


1 


1920 


20,673 


3 


.15 


1 


1921 


14,389 








1922 


10,447 








1923 


10,976 








1924 


11,625 


2 


.17 


1 


1925 


12,180 
12,732 
13,561 
14,260 
16,193 








1926 








1927 








1928 








1929 


1 


.06 


1 


1930 


15,524 








1931 


14,597 1 


.07 


1 



As will be noted from the table, a death from malaria among em- 
ployees has but seldom occurred during recent years. One death 
attributable' to malaria occurred among Panama Canal employees dur- 



36 

ing 1931. This case was that of a policeman who acquired his infection 
while on night duty. There was delay in his reporting to hospital, the 
infection was a malignant one of the cerebral type, the patient was 
comatose when admitted, and death occurred before quinine could 
affect the course of the disease. 

It is well known that estivo-autumnal (so-called malignant type) 
malaria is the type of most common occurrence on the Isthmus, and 
that not infrequently it manifests itself clinically as the cerebral form 
which may be fulminating and quickly result in death. When indi- 
viduals report with temperatures above normal, every effort is made to 
ascertain as quickly as is practicable if they have malaria. When a 
death from malaria does occur it usually is found that the individual 
has delayed in reporting for treatment and is en extremis when first 
seen by a physician. 

DIVISION OF HOSPITAL, DISPENSARIES, AND CHARITIES. 

The Panama Canal maintains two general hospitals to meet the 
medical and surgical requirements of the population residing in the 
Canal Zone (Panama Canal employees and their dependents, Army 
personnel, other Government employees, and others entitled to treat- 
ment). 

Gorgas Hospital (formerly known as Ancon Hospital), constructed at 
a cost of $2,000,000 with a normal capacity of 800 patients, is located 
in Ancon on the Pacific side, and Colon Hospital, constructed at a cost 
of $255,000 with a capacity of 130 patients, serves the population at 
the Atlantic terminal. 

The insane from the populations of the Canal Zone and the Republic 
of Panama are cared for in an asylum for the insane maintained by the 
Health Department at Corozal, two miles north of Balboa, near Mira- 
flores Locks. A new concrete fireproof ward for male patients was 
completed and occupied during the year. 

All cases of leprosy found in the Canal Zone and in the Republic 
of Panama are treated in the Palo Seco Leper Colony, maintained by. 
the Health Department of the Panama Canal in an isolated locality 
on the west side of the Canal at the Pacific entrance. 

The Health Department maintains dispensaries in the more impor- 
tant permanent towns, staffed by from one to three physicians and the 
necessary number of dispensary assistants, ambulance drivers, and 
attendants. The physicians on duty in these dispensaries have regular 
office hours during which employees and their families consult them free 
of charge. 



37 

In addition to the charity work done in its general hospitals and in 
the institutions for the care of the insane and lepers, the Health Depart- 
ment also cares for crippled employees, those suffering from chronic 
disabling diseases, and those unable to work on account of advancing 
age, in a special department located on the reservation of the Corozal 
Hospital for the insane and administered under the direction of the 
superintendent of that institution. 

The annual reports of the various institutions comprising this 
division of the Health Department follow: 

GORGAS HOSPITAL. 

(Normal capacity 880 beds.) 

Col. Arthur M. Whaley, Medical Corps, U. S. Army, Superintendent. 

There has been no new construction of buildings during the year. 
However, climatic conditions necessitate constant attention and con- 
siderable work to prevent deterioration of hospital buildings and equip- 
ment. The routine work of maintenance and repair, including re- 
painting of furniture and equipment, also the maintenance of plumbing 
and electrical repairs, were done by the hospital artisans, also certain 
alterations and many articles of furniture and equipment were made 
by the hospital maintenance force. 

New equipment and replacements of worn-out or obsolete articles, 
amounting to approximately $12,000, have been purchased and in- 
stalled during the year. 

Cases treated. — There were 12,239 admissions during the year, with 
a total of 165,150 patient days, making an average of 13.08 days spent 
in hospital per patient. The average number of beds occupied daily 
during the year was 452.47. 

Surgical service. — There were 2,317 major operations (with 31 
deaths) and 5,010 minor operations (with 1 death) performed during 
the year; 452 obstetrical cases were delivered, in which there were 5 
twin births and 27 stillbirths; 8,983 patients received treatment in the 
out-patient clinic. 

' Medical service. — The medical service is organized to furnish a com- 
plete service in internal medicine, including consultation service for 
both medical and surgical services of this hospital. 

During the past year 6,006 patients were treated in the medical 
wards. In addition to the hospital service, an active out-patient clinic 
is conducted where 8,646 patients received treatment. 



38 



Eye, ear, nose and throat services. — There were 11,387 visits to the 
out-patient department; 2,424 operations were performed and 1,307 
refractions were done. 

Radiographic service. — There were 6,946 cases, for which 16,560 
films of various sizes were used, and in which 932 fluroscopic examina- 
tions were made. 

Dental service. — There were 6,496 sittings during the year; 1,838 oral 
examinations and surveys; 3,209 teeth extracted; 582 complete and 818 
partial X-ray examinations. 

Physio-therapy service. — Treatments were given to 1,146 out-patients 
and 974 hospital in-patients, during the year. 

REPORT OF OUT-PATIENT SERVICES. 



Medical service 

Surgical service 

Eye, ear, nose and throat service . 

Physiotherapy service 

X-ray service 

Dental service 



Total . 



Total 
visits. 



11,387 

6,501 
1,313 
1,272 



New 

cases. 



1,861 

2,530 

4,266 

266 

982 

648 



38,122 10,553 



Pay 

cases. 



1,141 
335 
853 
108 
300 
747 



3,484 



BOARD OF HEALTH LABORATORY. 
(Operated in connection with Gorgas Hospital.) 

Dr. L. B. Bates, Chief of Laboratory. 

Bacillus typhosus. — Recovered in blood culture from 6 individuals 
and from stool specimens of 4 others. Two of the latter were from 
typhoid fever contacts. Of the 8 cases, 3 were from Colon, 2 from New 
Cristobal, 2 from Panama City, and 1 from a ship in transit. 

Typhoid carriers. — On December 31, 1930, there was only one B. 
typhosus carrier, H. B., under sanitary surveillance. His stool speci- 
mens were examined monthly and found positive on seven occasions. 
No new carriers were found during the year. He was still under sani- 
tary surveillance on December 31, 1931. 

Typhus fever. — Typhus fever has been practically an unknown disease 
in the Canal Zone and in the Republic of Panama. The diagnosis in 
the few suspicious cases has been open to reasonable doubt. Two blood 
specimens submitted for Weil-Felix agglutination tests during the 
present year have agglutinated B. proteus X-19 in rather high dilutions. 
Both patients ran clinical courses consistent with those seen in typhus 
fever. 



39 

Case 1. Mr. A. A., patient in the Panama Hospital, age 32, white, a resident of 
Panama City for four years, gave a positive Weil-Felix reaction in a dilution of 
1-640 on the 15th day of the disease just as the temperature was coming to normal. 

Case 2. Mr. R. R. A., patient in Santo Tomas Hospital, age 28, white, a resident 
of Panama City, gave a positive Weil-Felix reaction in a dilution of 1-1280 on the 
16th day of illness, two days after the temperature became normal. It is believed 
that these were both bona fide cases of typhus fever. 

Mononucleosis. — During the months of January and February, 
1931, blood films from 14 patients suspected of having infectious mono- 
nucleosis were examined in the Board of Health Laboratory in con- 
junction with those from other patients in whom this disease was not 
considered. All but 3 of the 14 suspected cases had a slight but definite 
increase in the percentage of monocytes. In the 3 cases, the per cent 
of monocytes was 1, 4, and 10 respectively. The percentage in the 
remaining cases ranged from 12 to 26, the average being 20 per cent. 
The total leucocyte count raged from 5,200 to 15,000 cells per cubic 
millimeter. The average leucocyte count for the 14 cases was 9,096. 
All but 3 cases were adults, with severe prostration, slight fever, 
occasional glandular enlargement and symptoms of upper respiratory 
infection, suggestive of influenza. The acute symptoms lasted from 3 
days to 1 week, but the patients did not fully recover for 2 or 3 weeks. 
The findings on these patients were not sufficiently marked to establish 
a. diagnosis of mononucleosis. These cases were probably mild forms 
of influenza. 

Reports. — Approximately 53,368 reports not including duplicates 
have been made. 

BACTERIOLOGICAL PROTOZOAL AND MISCELLANEOUS EXAMINATIONS. 

Blood cultures 294 

Positive for B. typhosus 6 

Positive for Staphylococcus albus 5 

Positive for Staphylococcus aureus 9 

Positive for Streptococcus hemolyticus 1 

Positive for Streptococcus viridans 4 

Positive for Streptococcus viridans and Staphylococcus albus 2 

Positive for Pneumococcus and Staphylococcus albus 1 

Positive for Pneumococcus 3 

Positive for B. coli 1 

Stools cultured for typhoid dysentery group 1 , 131 

Positive for B. typhosus 16 

Positive for B. typhosus on carriers 7 

Positive for B. dysenteriae, Group II 4 

Positive for B. dysenteriae, uot classified 1 

Urines cultured for typhoid group 648 

Positive for B. typhosus 3 

Urines cultured for organisms other than typhoid group 418 

Positive forB. coli Ill 

Positive for B. coli and Staphylococcus albus 1 

Positive for Staphylococcus alius 20 

Positive for Staphylococcus aureus 4 

Positive for Streptococcus hemolytic 2 

Positive for Streptococcus non-hemolytic 1 

Positive for Gram negative bacilli 2 

Throat cultures for B. diphtheriae 1 ,083 

Positive for B. diphtheriae 56 

Nasal cultures for B. diphtheriae 337 

Positive for B. diphtheriae 13 



40 

Throat cultures for organisms other than B. diphtheriae 46 

Positive for Streptococcus viridana 9 

Positive for Streptococcus hemolyticus 4 

Positive for Streptococcus anhemolyticus 1 

Eye cultures 32 

Positive for Staphylococcus aureus 3 

Positive for Staphylococcus aureus and albus 1 

Worm from eye for identification 1 

Ear cultures 2 

Mastoid cultures 1 

Nasopharyngeal cultures 42 

Positive for Meningococci 4 

Sputum cultures 35 

Positive for Pneumococcus Type I 1 

Positive for Pneumococcus Type II 1 

Positive for Pneumococcus Type IV 2 

Positive for Streptococcus viridans and Staphylococcus albus 2 

Sputum for yeast 3 

Positive for yeast 2 

Spinal fluid cultures 127 

Positive for Meningococcus 8 

Positive for Staphylococcus aureus 1 

Positive for B. pyocyaneous 1 

Positive for Genus proteus 4 

Surgical tissues cultured 2 

Positive for Clostridium welchii 1 

Pleural fluid cultures 31 

Positive for Streptococcus viridans 1 

Positive for Pneumococcus 2 

Knee fluid cultures : 15 

Wrist fluid cultures 1 

Ascitic fluid cultures 1 

Positive for Pneumococcus 1 

Cultures from skin lesions 26 

Cultures of pus from various sources 25" 

Positive for Staphylococcus albus 2 

Positive for Staphylococcus aureus 7 

Autopsies cultured 35 

Organs, exudates, etc 27 

Bile cultures. 12 

Breast milk, microscopic examination 1 

Mold cultures from paintings in Administration Building 1 

Darkfield examinations 62 

Conjunctival smears 58 

Positive for Gram negative intracellular diplococci 19 

Positive for Koch Weeks bacillus 2 

Throat smears 55 

Positive for fusiform bacilli and spirilla of Vincent's angina 20 

Smears from venereal lesions 5 

Smear from skin for Leishmania 1 

Smear from skin for fungus 2 

Urethral smears 54 

Positive for Gram negative intracellular diplococci 16 

Vaginal smears 55 

Positive for Gram negative intracellular diplococci 14 

Sputum smears for B. tuberculosis 74 

Positive for B. tuberculosis 7 

Urine examined for B. tuberculosis 2 

Spinal fluid for B. tuberculosis 24 

Positive for B. tuberculosis 2 

Cell count of spinal fluids 7 

Examination of leper suspects 10 

Positive for B. leprae 9 

Examination of lepers previous to parole 1 

Examination of paroled lepers 6 

Positive for B. leprae 3 

Autogenous vaccines prepared 33 

Feces examined for parasites and ova 104 

Positive for Uncinaria ova 1 

Positive for Endamoeba histolytica 1 

Positive for Entamoeba coli 1 

Positive for Taenia saginata (segments and ova) 1 

Positive for Ascaris lumbricoides ova * 

Positive for Strongyloides larvae 1 

Differential counts 8 

Red blood counts 13 

White blood counts 10 

Blood films examined for malarial parasites 590 

Positive for Tertian malarial parasites 264 

Positive forE. A. malarial parasites 221 

Positive for Quartan malarial parasites 3 

Positive for Tertian and Quartan malarial parasites combined '3 

Positive for Tertian and E. A . malarial parasites combined 3 

Blood films examined for Trypanosomes » ■ 1 



41 



Water from Balboa Clubhouse swimming pool 

Water from Balboa Army and Navy Y. M. C. A. swimming pool . 

Water from Pedro Miguel Clubhouse swimming pool 

Water from Union Club swimming pool 

Water from Fort Clayton swimming pool 

Water from Fort Amador 

Water from Corozal 

Water from Quarry Heights 

Water from Fort Randolph 

Water from France Field 

Water from Fort Sherman 

Water from Submarine Base, Coco Solo 

Water from reserve reservoir, Gaillard 

Water from matadero, Panama 

Water from Madden Dam 

Water from Chorrera, Republic of Panama 

Water from Santa Clara Inn 

Well water from Santa Clara Beach Project 

Water from Volcan, Republic of Panama 

Water from Nicaragua 

Dairy water submitted by Health Office, Panama 

Dairy water submitted by Health Office, Cristobal 

Well water from Panama City 

Well water from Paja 

Well water from Pina Guapa Island 

Ice from ice factory at Chorrera, Republic of Panama 

Foodstuffs examined : 

Cultures of fish 

Ice cream cultured for bacterial count 

Cultures of milk, condensed 

Milk cultured for bacterial count (dairy) 

Culture of milk, powdered 

Cultures of sausage (positive for B. coli) 

Soda water for B. coli 

Syrups used in soda water 



297 
291 
153 

21 

2 

165 

10 
1 
5 
1 
1 
6 
2 
2 
5 
1 
1 
3 
1 
3 

22 
4 

11 
1 
3 

22 



2 
14 

2 
577 

1 

1 
358 

■1 



SEROLOGICAL EXAMINATIONS. 



Wassermann tests . 
Kahn tests. 



Agglutination tests 

Positive with B. typhosus 

Positive with B. paralyphosus B 

Positive with B. dysenteriae Group II. . 

Positive with B. proteus X 19 

, Fragility tests. 

' Blood typing for transfusion 

Examination of blood for coagulation time. 
Examination of blood for bleeding time 



22,118 
111 

105 



Analysis of Wassermann reactions. — Twenty-one thousand two hun- 
dred and forty-two Wassermann tests were performed on the blood of 
15,717 persons. The results are summarized below: 

TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE 
AT BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1931. 



Race, sex, and status. 


Individuals 
positive. 


Individuals 
negative. 


Total 

individuals 

tested. 


Per cent of 

individuals 

positive. 


White, civil: 


145 
35 


2,068 
624 
35 


2,213 
659 
35 


6.55 




5.31 












Total 


180 


2,727 


2,907 


6.19 






White, military and naval: 


230 
32 


4,285 
378 


4,515 
410 


5.09 


Sailors, U. S. N 


7.80 


Total 


262 


4,663 


4,925 


5.32 


Black and mulattoes: ' 


841 

521 

17 


3,385 

2,808 

285 


4,226 

3,329 

302 


19.90 




15.65 




5.63 






Total 


1,379 


6,478 


7,857 


17.55 




11 


17 


28 


39.29 






Grand total 


1,832 


13,885 


15,717 


11.66 



42 



In addition, Wassermann tests were made on 876 spinal fluids taken 
from 707 individuals. The results are summarized as follows: 

Individuals positive 70 

Individuals negative 637 

Total individuals tested 707 

Per cent of individuals positive 9 90 



THE MORE FREQUENT CAUSES OF DEATH FOUND AT AUTOPSY IN BOARD OF HEALTH 
LABORATORY, 1904 TO 1931. 



Year. 


s 

o 

II 


'c 

o 

a 

c 


■a 

g 

■s 


d 
.2 s 

~ a 

.S-o 

IE 

w 


3 S 

•o 

c a 

a| 

.2 8 

S >> 
£•= 

■3 


ja 

a. 

e 

'S 
o 

-a 
O 


"c 

00 

-a aJ 

~ c 

o 


-5 

3 

B 

J3 

'I 
« 
9 

O 


a? 
> 

D 

-3 

'3 
j= 
p, 
>> 


-a o 
c £ 

J! 

g.a 


a 

03 

o 


M.5 

1-3 

= — 

of"* 

2 = 

— i 
>> 


1904 


6 
269 
509 
496 
361 
295 
451 
508 
425 
460 
375 
328 
323 
330 
253 
324 
334 
289 
262 
205 
263 
306 
282 
358 
436 
453 
375 
388 


i 

60 
191 
156 
59 
55 
50 
83 
53 
47 
36 
28 
25 
24 
38 
22 
'46 
14 
14 
6 
14 
15 
14 
27 
45 
40 
26 
31 


1 
9 
22 
35 
63 
37 
91 
102 
79 
89 
78 
56 
81 
51 
68 
55 
55 
37 
29 
17 
33 
34 
32 
22 
40 
44 
40 
34 




















1905. . . . 

1906. . . . 

1907... 

1908... 

1909... 

1910... 

1911 . 

1912... 

1913.... 

1914. 

1915... 

1910.. 

1917 ... 

1918... 

1919.... 

1920 


27 
50 
27 
46 
26 
52 
41 
23 
21 
6 
14 
8 
5 
6 
3 

4 
5 
3 
3 
7 
5 
10 
8 
6 
2 

11 


3 

24 
40 
26 
32 
30 
38 
37 
34 
38 
20 
17 
21 

6 
15 
29 
16 
19 

9 
29 
38 
32 
35 
40 
48 
45 
68 


8 
23 
27 
25 
31 
37 
36 
27 
26 
12 
12 
20 
23 
12 
14 
11 
5 
9 
9 

10 
11 
9 
17 
20 
21 
26 
16 


5 

39 

36 

23 

11 

36 

19 

15 

8 

6 

5 

7 

3 

3 
5 

8 
4 
5 
4 
3 
2 
3 
3 
5 
1 
3 


3 
15 
12 
11 
17 
16 
20 
22 
26 
27 
14 
10 
18 

8 

20 
16 
17 

9 
12 
21 
18 
11 
19 
13 
10 
23 
20 


9 
33 
58 
14 
11 
10 
9 
6 
5 
5 
2 
6 
1 

3 


4 

1 

6 
11 

7 
23 
14 
IS 

9 

:; 

1 

10 


2 
2 
4 
7 
5 
4 
11 
11 
12 
3 
10 

5 

11 
6 
7 

10 
11 
13 
16 
13 
21 
Hi 
23 
15 
17 


1 
2 

.1 

2 
11 
5 

9 
15 
12 

5 

8 
15 


1921... 
1922... 
1923... 
1924.... 
1925... 
1926. . . . 
1927. . . . 
1928... 
1929... 
1930. . . . 
1931... 


2 

3 

o 

1 
1 

2 
2 
4 
3 
1 


4 
6 
1 

3 
3 
5 
1 
10 
11 
1 
10 


20 
14 
14 
12 
17 
25 
23 
46 
37 
48 
41 


Total . 


9,664 


1,220 


1,334 


419 


789 


497 


262 


428 


193 


159 


270 


383 



' This includes 32 cases of influenza. 

The 1930 Annual Report, page 54, contains a table showing num- 
ber of autopsies performed from 1904 to 1930 in certain rare diseases. 
The 1931 additions to this table are as follows: Yellow fever 0, 
beriberi 1, anklyostomiasis 0, tetanus 0, infectious diseases of 
children 1, plague 0, smallpox 0. 

Per cent bodies autopsied. — Five hundred and sixty-nine bodies (not 
including 11 for storage only and 6 disinterred) passed through the 
laboratory; 388 or 68.19 per cent were autopsied. 



Malaria carriers found at autopsy. . 
Syphilis found at autopsy (cases). . . 
Glycosuria found at autopsy (cases) 



43 



Intestinal parasites found at autopsy. — Twenty-nine cases in 388 
autopsies performed at the laboratory, or 7.47 per cent, showed one or 
more parasites or their ova, as follows: 



Ascaris.. . 
Uncinaria. 
Trichuris 



'Oxyuris 

Trichoccphalus dispar. 



Multiple infections occurred as follows: 



Uncinaria and trichuris 

Trichoccphalus dispar and uncinaria . 



Ascaris and uncinaria 6 

Ascaris and trichuris 1 

Ascaris, uncinaria and trichosephalus 1 

CAUSE OF DEATH FOUND AT AUTOPSY OF LEPERS IN BOARD OF HEALTH LABORATORY, 1931. 



Autopsy 
No. 

9337 
9346 
9362 
9366 
9402 
9442 
9602 



Cause of death. 



Contributory cause. 



Leprosy . 
Leprosy . 
Leprosy . 
Leprosy . 
Leprosy . 
Leprosy . 
Leprosy . 



Acute vegetative endocarditis. 
Acute gangrenous appendicitis. 
Pulmonary tuberculosis. 
Severe f urunculosis. 
Arteriosclerosis, general. 
Acute enterocolitis. 
Syphilitic aortitis. 



WILD AND DOMESTIC ANIMALS. 



Bacteriological: 

Blood smear from cow for Trypanosomes 
and Piroplasma (negative) 

Blood smears from horses for Trypanosomes 
and Piroplasma (negative) 

Blood smeara from horses for Trypanosomes 
(negative) 

Cattle ear for anthrax (negative) 

Cultures of autopsy material (guinea pigs) 

Spleen cultures from guinea pigs 

Positive for5. paratyphosus B. 5 

Spleen cultures from rabbits (negative) .. . . 

Gut and lung cultures from turkey (nega- 
tive) 

Organs and exudate cultures fron bird 
(negative) 

Totai 



Autopsies: 

Boars 

Guinea pigs. 
Rabbits .... 



Total . 



Histological examinations: 

Autopsy tissues from cows 

Positive for B. tuberculosis . 
Positive for Pneumococcus . 



Total . 



Serological : 

Complement fixation test for glanders 
on mule (negative) 



P^ats examined: 

Mus musculus.. . . 
Mus alexandrinus. 
Mus norwegicus . . . 
Mus rattus 



Total . 



Total . 



MICROSCOPIC SLIDES PREPARED. 



Surgical tissue preparations (6 frozen). 

Autopsy tissue preparations 

Animal tissue preparations 



2,109 

81 

302 

2,014 

4,506 



2,280 

6,554 

181 



. Total 9 , 015 



PHOTOGRAPHS. 



M. F., Gorgas Hospital No. 330355— acromegalia 

M. B., Gorgas Hospital No. 323712— harelip 

A. R. H., Co'on Hospital No. 94302— tumor 

Property Clerk, Gorgas Hospital— valve on oxygen tank . 



Total . 



CHEMICAL ANALYSES AND EXAMINATIONS. 



Alcohol analyses. 



Beer, alcohol determinations. . . . 

Kafir, alcohol determinations 

Soda water for saccharine 

Soda water for salicylic acid 

Positive for salicylic acid. . . 
Whisky, alcohol determinations 



44 



Blood 

Nonprotein nitrogen determinations 1 , 651 

Urea nitrogen determinations 235 

Uric acid determinations 180 

Creatinin determinations 631 

Glucose determinations 1 , 826 



2,005 



Calcium determinations . 

Cholesterol determinations 

Carbon dioxide determinations. . 

Sodium chloride determinations. 

Carotin determinations 

Icterus index 

Van den Bergh tests 

Calibration — sphygmomanometer — 

Chlorine solution 

Drugs and chemicals 

Boric acid 

Calx chlorinata 

Carbolic acid, crude 

Cattle dip, arsenical 

Creosote, Beechwood 

Sodium thiosulphate 

Foodstuffs. 



Butter 

Cream 

Fruit, canned (sugar) . 

Icecream 

Lard. 



Milk, condensed, unsweetened 

Milk, condensed, sweetened 

Milk, dairy 

Milk, evaporated 

Milk, mothers 

Milk, powder 

Oleomargarine 

Garbage (moisture, combustible matter and ash) . 

Gastric analyses 

Mud for corrosive agents 

Naphthalene in gas 

Oils, specific gravity 

Oil, viscosity. 



Phosphorus determination (roach paste) 

Salt, pickling, nitrate determination 

Soda solution, washing 

Spinal fluids 

Colloidal gold tests 

Globulin tests. 

Glucose determinations 

Substances for identification 

Cocaine ; 

Morphine, solution 

Narcotic (negative) 

Opium, suspected (negative) 

Oxalic acid in magnesium sulphate crystals 

Oxalic acid in magnesium sulphate solution 

Toxicological 

Fish (arsenic, trace) 

Meat (positive for strychnine) 

Phosphorus tests (yellow phosphorus) 

Banana (positive for phosphorus) 

Chickens (2 positive for phosphorus) 

Dog (negative) 

Stomach and contents (negative for volatile poisons, alkaloids and heavy metals) . 

Stomach and contents (negative for corrosive metals) 

Stomach and contents (negative for alkaloids) 

Stomach, intestines and liver (positive for phosphorus) 

Water for poisons (negative) 

Urine 

Acetone 

Blood 

Diacetic acid determinations 

Glucose determinations 

Hemoglobin 

Lead determinations (124 positive) 

Mercury determinations (negative) 

Routine analyses 

Vomitus, for blood 

Water for chlorides 

Water for mineral analyses 

Acetone, recovered (liters) 

Alcohol, recovered (liters) 

Benzol, recovered (liters) 

Chaulmoogra e3ters prepared (liters) 

Dakins solution prepared (liters) 

Termite poison prepared (liters) . . . 



18 
3 

15 

2 

1 

127 

1 



5 
4 
3 
84 

1 
1 
1 
560 
I 
7 
2 
4 



839 
838 
39 



1 

6 

19 

1 

194 

1 

44 



4 
521 

1 



1 

2 

76 

878 



3 
17 

3 

68 
278 
64 
20 



45 

UNDERTAKING DEPARTMENT. 

Bodies received (including 6 disinterred) 586 

Bodies embalmed 101 

Bodies cremated 143 

Bodies buried on Isthmus (including 2 disinterred) 377 

Bodies shipped from Isthmus (including 4 disinterred) 74 

COLON HOSPITAL. 

(Capacity 130 patients.) 

Maj. Dean F. Winn, Superintendent. 

This hospital functions essentially as an emergency hospital although 
definitive treatment is provided for a wide range of cases. Individuals 
requiring special investigation, for which physical equipment is inade- 
quate, those with venereal diseases, and eye, ear, nose and throat cases, 
are transferred to Gorgas Hospital. 

There has been no increase in the number of beds during the year. 

No noteworthy additions to the hospital plant were made during 
1931 but the utilities department has been active in preserving the 
generally excellent appearance of the buildings and grounds and the 
upkeep of the various departments. 

The bearing capacity of the foundation bed for the new nurses' quar- 
ters has been tested and plans for this building as well as those for 
remodeling the old nurses' quarters for use as a dispensary, and for 
the construction of a new ward for private patients in the present 
dispensary section, have been approved. This work should be com- 
pleted during the coming year. 

The plans for the dispensary provide for a more commodious and 
convenient arrangement of examining rooms, laboratory, X-ray, and 
pharmacy in a detached building. This will relieve a great deal of 
congestion in the hospital proper. 

The new ward will afford accommodations for 12 semiprivate ward 
patients and 8 private rooms and will answer a long-felt need by 
relieving the congestion in ward "C" and permitting a more satisfac- 
tory segregation of patients. 

There were 4,505 admissions during the year, with a total of 41,508 
patient days, an average of 9.02 days in hospital per patient. 

Surgical service. — During the year there were 465 major operations 
and 888 minor operations. These afforded an interesting variety of 
surgical pathology and active emergency service. In addition, this 
service gave definitive treatment to 228 fractures. 

Spinal anesthesia — neocaine — was extensively used. Except in one 
case, in which failure was unexplained, it has proven entirely satis- 
factory, and preferable to ether in many cases. No accidents or 
untoward operative or post-operative symptoms occurred. 



46 

Obstetrical service. — This service is yearly becoming more active, 
there having been 522 deliveries during 1931 as compared with 489 in 
1930. Of this number there were 29 forceps deliveries and 8 Caesarian 
sections. There were 18 stillbirths. The majority of the cases were 
colored women among whom a surprising number of complications 
were encountered, eclampsia and pernicious vomiting being exceedingly 
common. 

An active and well-conducted prenatal clinic is maintained. 

Medical service. — The general medical service has increased in pro- 
portion to the added bed capacity. Except for contagious diseases, 
mental diseases, and cases of tuberculosis, which are transferred to 
Gorgas Hospital, the general scope of the work has been satisfactory 
in both volume and variety. 

X-ray department.— There were 1,585 examinations made during the 
year. This department is not equipped for giving Roentgen therapy. 

Laboratory. — Only routine work is done. Serological and patho- 
logical work is performed for the hospital by the Board of Health 
laboratory at Ancon, C. Z. 

Dispensary. — The Colon dispensary is an integral part of Colon 
Hospital. Its professional staff is frequently interchanged with that 
of the hospital proper. Through it comes a large percentage of hos- 
pital admissions. It is divided into three sections, viz., a silver clinic, 
a gold clinic, and a maternity and pediatric clinic. The number of 
persons examined and treated in the dispensary during 1931 averaged 
177 daily. Of the 64,689 patients treated, 24,909 were white and 39,780 
were colored. In addition, physicians on duty made 338 calls on 
patients at their homes and patients on board ships. 

COROZAL HOSPITAL. 

(Capacity, 750 patients.) 
Maj. S. L. Chappell, Medical Corps, U. S. Army, Superintendent. 

This institution cares for the insane of the Canal Zone and of the 
Republic of Panama, being reimbursed for the latter class of patients 
by the Republic at the rate of $0.75 per day. It also cares for alien 
employees of the Panama Canal and the Panama Railroad disabled 
by reason of injuries or chronic diseases, who desire to enter the institu- 
tion. 

The new 3-story male ward "A" (Building No. 525), on which 
construction work was started August 11, 1930, was completed and 



47 

occupied by patients on November 5, 1931. This building has a capac- 
ity of approximately 225 patients and embodies a number of improve- 
ments made since the construction of the female ward completed in 1927. 

Buildings 531 and 532, formerly known as wards "D" and "B," 
were purchased and razed by private bidders, patients from these 
buildings having been transferred to the new structure. 

Routine painting and repairs to woodwork, plumbing, boiler, steam 
line, etc., have been made by hospital artisans, with the help of patients. 

Insane patients. — The census on December 31, 1931, was 649, as 
compared with 598 at the end of the previous year. Of 3 transferred 
to Gorgas Hospital and remaining there at the end of 1930, 2 died and 
1 was returned. The number admitted was 297, as compared with 
296 for 1930. There were 189 discharges and 51 deaths. There 
were no suicides or deaths due to violence. 

Of the 189 discharged, 21 were considered as cured, 106 as improved, 
62 as unimproved; 93 were repatriated. Eighteen patients were 
transferred to Gorgas Hospital for treatment; 11 of these were returned 
to Corozal (also 1 who remained under treatment December 31, 1930), 
4 died, 1 was returned from there to Palo Seco Leper Colony, and 2 
remained in Gorgas Hospital at the end of the year. Of the admissions, 
135 were cases paid for by the Government of Panama and the remain- 
der were Canal Zone charity cases or private pay patients. 

Other patients. — There were on December 31, 47 black and 3 white 
chronically ill or crippled inmates (not insane), as compared with 53 
black and 6 white of this class at the beginning of the year. Seventeen 
were admitted, 2 repatriated to St. Vincent and Nicaragua, 1 died, and 
3 were transferred to insane status. Thirty-eight of these patients 
were transferred to Gorgas Hospital for treatment, and of these, 28 
were returned to Corozal Hospital, 6 died while in Gorgas Hospital, 1 
was repatriated to Jamaica, and 3 remained under treatment at Gorgas 
Hospital at the end of the year. In addition to the 50 carried on the 
census as of December 31, 1931, there were 10 remaining out on pass 
at the end of the year. All those capable of performing work were 
encouraged to do so. Eighteen were carried on the pay rolls, employed 
as broom makers, bandage rollers, janitor, laborers, and helpers. The 
broom makers manufactured approximately 220 brooms per week. 

Recreation. — Weekly picture shows and band concerts have been 
continued, and the patients appear to derive considerable pleasure 
from these forms of entertainment. Picnics were held twice a month, 
during the dry season in a grove back of the hospital, and during the 
rainy seasonjn the basement of one of the new ward buildings. Church 
services were held once a week for both the Catholic and Protestant 



48 

patients. The former are held in the chapel near entrance to hospital 
road, and the latter are conducted in the basement of the new women's 
ward. 

Treatment. — Intensive specific treatment was given to patients 
suffering from syphilitic psychoses. Five hundred and thirty-two 
doses of arsphenamin were administered intravenously, and 365 lumbar 
punctures were made. At the end of the year there were 50 patients 
suffering from neuro-syphilis in some form; 33 of these were males and 
1 7 were females. 

Occupational therapy. — On December 31, 1931, there were 16 male 
and 28 female patients under treatment in the occupational therapy 
department. The men are taught carpentry, weaving, bag making, 
recaning of chairs, rush work, etc. ; the women are taught to make rugs 
and baskets, and to sew, knit, embroideV, crochet, and make articles of 
raffia. The items produced and sold were: 172 rugs, 128 bags, 114 
ornamental baskets, 132 card-table covers, doilies and other embroidered 
pieces, 402 raffia purses, 387 pieces of furniture, 9 boats in bottles, 
12 knotted bags, 6 knotted belts, and 29 pieces of rush work. Sixteen 
pieces of furniture were painted and repaired. 

Other male insane who were strong physically but could not be 
accommodated in the occupational ward on account of limited space 
were sent to the fields and employed in agricultural activities. The 
value of the produce taken from the patients' garden for hospital use 
amounted to $1,524.91. The more vigorous females were assigned to 
tasks in the laundry, sewing room, or in the salvage department. As 
a result of these various undertakings, between 75 and 80 per cent of 
the patients are engaged in some form of work. All of the laundering, 
with the exception of bed sheets, pillowcases, and nurses' uniforms, 
was done by the patients. 

The total sales from the occupational ward amounted to $1,491.70, 
and from the brooms manufactured by the "chronics," $4,432.15, a 
total of $5,923.85. This money is utilized for material required to 
continue activities in these departments, and for tobacco, confections, 
fruit, refreshments, etc., for the patients. 

Farm. — Repairs to fences were made, and pastures were cleared of 
brush during the dry season by cutting and burning. 

There were 24 cripples employed on the farm at the close of the year, 
as compared with 26 at the beginning of the year. During this period 
1 was admitted, 2 quit, and 1 was repatriated to Jamaica. These men 
are employed in the garden, piggery, steam plant, cemetery, etc. Six 
(including one chronic patient) are tending plots of land in the farm 
reservation, which they cultivate as gardens and are paid on an actual 



49 

production basis. Their average earnings per month amounted to 
$33.68. Subsistence was furnished them free of charge. The receipts 
for produce sold aggregated $3,372.68, and for manure, $476.25. 

There were 112 pigs, 56 hogs, and 2 boars on hand December 31, 1 93 1 . 
Net revenue from the sale of pigs during the year amounted to $361.61 ; 
the gross revenue was $2,695.46. 



PALO SECO LEPER COLONY. 
Dr. Ezra Hurwitz, Superintendent. 

During the year, 34,947 days treatment were furnished. There were 
99 patients on January 1, 1931; 9 new patients were admitted, 3 
paroled patients were readmitted, 8 patients died, 2 were paroled and 
2 eloped, leaving 99 patients in the colony at the close of the year. Of 
these, 79 were for the account of the Republic of Panama and 20 were 
Canal Zone charity cases. 

Administration of the iodized ethyl esters of chaulmoogric acids 
continued as the routine treatment. The average dose was 5 cc, given 
intramuscularly. Sixty-one patients received injections semiweekly, 
23 weekly, and 20 biweekly. Three received crude chaulmoogra 
oil by mouth, and 4 patients refused treatment. Seven patients 
were transferred to Gorgas Hospital for special treatment; 3 for 
orthopedic service, 2 for obstetric service, 1 for major surgical serv- 
ice, and 1 for treatment of the eye. 

Housing facilities of the colony continued to be entirely inadequate. 
Only 29 rooms were available for 70 men, and 9 rooms for 23 women 
patients. 

There was one marriage among the patients during the year. There 
are now three married couples living together and two married couples 
living apart, in the colony. Of the two pregnancies that occurred, one 
aborted at the seventh month, the other terminated in normal labor 
at term, but the child lived only one and one-half months. 

The total of the monthly gratuitous allotments to the patients 
amounted to $1,516.50. In addition they received for labor performed 
for the colony, $3,485.64, and for produce sold the colony, $481.15. 
Gifts of useful articles were donated by Rev. A. E. Gay, the Panama 
Red Cross Society, the Women's Auxiliary of the Gatun Union Church, 
and the Cristobal Women's Club. Bishop H. R. Carson gave an ex- 
cellent Christmas dinner, and the Sociedad Espanola de Beneficencia 

MR 31053—4 



50 

of Panama donated special refreshments on Columbus day. Motion 
pictures were shown weekly throughout the year. Four concerts 
were given by as many amateur bands of Panama, and two exhibitions 
of ventriloquism and magic were given by itinerant artists. The short - 
wave radio set, the phonograph, the two pool tables, the motion 
picture and recreation building continued to give pleasure to the 
patients throughout the year. 

DIVISION OF SANITATION. 

Organization and activities.— The plan of organization of this division 
and the principal activities in which it is engaged were outlined some- 
what in detail in the annual report for 1930, pages 73 to 77, to which 
publication reference should be made for detailed information. 

ROUTINE AND SPECIAL ACTIVITIES UNDERTAKEN DURING 1931. 

Routine activities were the usual mosquito control work, including 
maintenance work on permanent drainage projects, oiling, weekly out- 
of-doors catches of mosquitoes (6 to 8 p. m.) at designated stations 
throughout the Zone with identification and report of species captured, 
search for and identification of larvae, and special inspection of all 
drainage systems near the end of the dry season with removal of ob- 
structions, repair of ditches, regrading of ditch bottoms, straightening 
and training of stream beds, and digging of new ditches when necessary. 

SPECIAL PROJECTS UNDERTAKEN DURING 1931. 

(a) Medical care of the population in the Madden Dam area.— It was 
pointed out in the annual report for 1930 that the construction of the 
Madden Dam would begin in 1931 . This dam is located on the Chagres 
River about 12 miles above Gamboa, the point at which the river dis- 
charges into the Canal. When completed the dam will provide an 
adequate reserve supply of water and a hydroelectric plant for all 
Canal requirements for many years to come. The surface area of the 
reservoir will be approximately 22 square miles and its capacity will- 
be 22 billion cubic feet of water. Contracts for construction were 
awarded September 12, 1931 , and the contractor began work October 13, 
1931. It is probable that construction activities will continue in that 
area for about 4 years and the strength of the force (Panama Canal 
and contractor's) engaged on the work will range, during the period, 
somewhere between 500 and 1,000 men. For the past two years or 
more the Gorgas Institute, in cooperation with the Health Department, 
has been making special studies of the malaria situation in the popula- 



Sanitated Areas 
Before 1919 IIIHI S 



1919 - 1924 
1925- 1926 




Cut No. 2.^Showing the area now sanitated, and regularly inspected, at the Atlantic end of the Canal. 



51 

tions living in the vicinity of the dam area. These villages are located 
on the Chagres River and alongside the Madden Road leading from 
the Canal to the Madden Dam. The Madden Road (concrete, 18 feet 
in width) was completed in April, 1930, and since its completion large 
numbers of farmers have occupied small areas in the immediately 
adjacent parts of the Republic of Panama. It is estimated that the 
population in that area has increased by about 200 persons during the 
past year. 

The population in the 5 villages of the Chagres River near the site 
of the Madden Dam is about 600. The average parasite rate in these 
villages for a year under monthly surveys and voluntary quinine ad- 
ministrations, was 25.6 per cent for children and 16.2 per cent for 
adults. The average parasite rate for the year on total population in 
the 5 Chagres River villages was 21.6 per cent. The Madden Road 
population, total about 250, slightly exceeded this rate. 

Prior to initiation of the monthly blood surveys, followed by volun- 
tary quinine treatment, the 5 Chagres River villages revealed a para- 
site rate of 56.5 per cent for children and 37.2 per cent for adults. 

The average monthly parasite index for the labor forces under the 
direct control of the Panama Canal in the camps of Madden Dam and 
the Thatcher Highway was 4.4 per cent. 

The records indicate that if all individuals constituting the popu- 
lations were observed throughout a period of a year it would be found 
that practically 100 per cent of them have malaria at one time or 
another. 

The monthly blood surveys of these populations with treatment of 
those infected will be continued during 1932. This control measure is 
being carried out in the hope that the number of gamete carriers in 
the Madden Dam area may be reduced to some extent, thus influencing, 
in some degree, the possibility of mosquitoes acquiring infection. In 
1932 it is proposed to supplement the regular quinine treatment with 
plasmochin. 

In the construction camps located in the area the Health Department 
has put into effect the following malaria control measures: 

1. Adequate screening of all buildings to be occupied by human beings. 

2. Elimination of mosquito breeding in the immediate vicinity of the camp. 

3. Insistence that all persons not engaged in work that necessarily requires ex- 
posure at night should remain in screened houses between dusk and daylight. At 
times night shifts will be on duty. 

4. Catches or mosquitoes inside barracks each morning, with identification of 
species captured. 

5. Monthly blood surveys of all persons living in the camps, with treatment 
(quinine and plasmochin) of those infected. It is hoped that this routine treatment 



52 

may possibly reduce the number of carriers of malarial organisms and it certainly 
will lessen the labor turnover. 

6. A dispensary service at the camp to care for accidents and injuries and to 
provide a medical service for minor ailments. Injuries and illnesses of a serious 
nature are transferred to Gorgas Hospital in Ancon, at the Pacific terminus of the 
Canal. 

To carry on these activities the Health Department maintains the 
following organization at the dam site: 

1 dispensary physician. 

1 pharmacist. 

2 attendants (colored assistants in the dispensary who also act as chauffeurs). 
1 ambulance. 

1 sanitary inspector, part time, in charge of mosquito control activities. 

1 foreman, colored, and gang of 6 men who maintain drainage, search for and oil 
mosquito breeding areas, capture mosquitoes in barracks, and administer quinine 
to colored laborers and other infected persons living in the area. 

The cost of this service to the Government (including maintenance 
and operation only) averages about $1,600 per month. 

THE ANOPHELINE MOSQUITOES OF THE ISTHMUS. 

(By D. P. Curry) 

The known anophelines (tribe Anophelini) of the Isthmus now num- 
ber 15, as follows: 

Stethomyia — 

kompi Edwards. 
Chagasia — 

bathanus Dyar. 
Anopheles ( Nyssorhynchus) — 

albimanus Wiedemann 

bachmanni Petrocchi 

strodei Root 

tarsimaculatus Goeldi (?) 
variety aquasalis Curry 
variety aquacaelestis Curry 

argyritarsis Robineau-Desvoidy 

albitarsis Lynch Arribalzaga 

(Anopheles) — 

eiseni Coquillet 

pseudopuncti pen n is Theobald 

punt ti macula Dyar and Knab 

apicimacida Dyar and Knab 

neomaculi palpus Curry 
( Kerteszia) — 

cruzii Dyar and Knab 



53 

Of this rather imposing list it seems that only one species, A nopheles 
albimanus, is important as a malaria carrier. 

Of the two listed varieties of A. tarsimaculatus, one or both may be 
valid species and not really A. tarsimaculatus Goeldi; this was dis- 
cussed in a paper recently presented by Dr. Curry. ' The fresh water 
species or variety, A. (t.) aquacaelestis, has been found breeding 
in enormous numbers in the vast, densely shaded swamps of the lower 
Chagres River on the Atlantic side of the Isthmus. Along the edge 
of the swamp near the Mojinga River (a small tributary of the Chagres) 
many hundreds of aquacaelestis were taken in a few minutes one evening 
with a small sweep-net swept back and forth in the beam of a pocket 
flash-light; the air seemed to swarm with them as the light played 
on their glistening white hind tarsi. Early next morning myriads of 
these rested on the twigs and leaves of the dense vegetation. In spite 
of the presence of so many of these mosquitoes, but few of them 
attacked the searching party. Only an occasional one alighted on 
human skin or clothing. A sanitary inspector, sleeping at night in 
an unscreened shelter in the swamp, purposely left his mosquito net 
open throughout the night. Next morning in his net were found seven 
engorged A. punctimacula and but one aquacaelestis, although in the 
catch with the sweep-net there were hundreds of the latter to every 
one of the former. The evidence seems conclusive that A. tarsimacu- 
latus variety aquacaelestis is but slightly homophilous. Neither vari- 
ety of A. tarsimaculatus has been taken or found breeding on the 
Pacific side of the Isthmus or in the higher inland country. 

A. albitarsis, recently reported from the Canal Zone, breeds pro- 
lifically in surface patches of bladderwort (Utricularia mixta) in Gatun 
Lake and has as yet been found in no other habitat. It is especially 
prevalent in the latter part of the dry season when the amount of this 
plant exposed on the surface is vastly increased by reason of the low- 
ered water of the lake. At such time the total area of exposure of 
this plant over the shallower parts of the 165 square miles of Gatun 
Lake must be enormous. Yet in unscreened homes and the tents of 
military personnel encamped nearby only engorged A. albimanus are 
taken in the morning, indicating that perhaps albitarsis, too, is but 
slightly interested in mankind and therefore is perhaps not so impor- 
tant as a malaria carrier. Associated with A. albitarsis in the bladder- 
wort patches have been taken larvae of A. albimanus, A. bachmanni 
and A. strodei. 

A. bachmanni had not heretofore been taken except in association 
with the aquatic aroid, water lettuce (Pistia stratiotes), and its recent 

■Observations on the Nvssorhynchns group of the Anopheles of Panama. Amer. Jour. Hyg., Vol. 
XV, pp. 556-572. 



54 

appearance in the bladderwort patches may perhaps be explained by 
the fact that the Pistia has of late largely disappeared from the waters 
of the Canal Zone. In many ponds, sluggish streams and lake inlets 
that formerly were nearly choked with a luxuriant growth of water 
lettuce, can now be found hardly a plant of it. 

On the other hand, the Utricularia and one or more species of Char a 
are on the increase in lake waters. It is not to be wondered at that 
these changes are occurring. It must be remembered that less than 
20 years ago where Gatun Lake now lies was rolling hill land and jungle 
and running streams. Changes in the plant and animal life of the 
region must continue for many years to come as nature adjusts her- 
self to the tremendous alteration that has been forced upon her by the 
construction of the Canal and its tributary lakes. 

Even as striking as the limitation of A. albitarsis to Utricularia is 
the even greater prevalence of A. albimanus in similar patches of 
Chara. Chara has apparently been established in the lake waters here 
for a longer time than the Utricularia. At least it is more widespread," 
there is much more of it, and when the greater amount of sunlight and 
the lowered lake of the dry season have carpeted acres of water surface 
with this ideal source of food and shelter the larvae of A. albimanus 
teem upon it. 

For some time it has been noted that toward the end of the dry season 
there have been flights of A. albimanus into the sanitated areas, ap- 
parently from unknown distant sources, before the fall of enough rain 
to create new breeding places. It is now suggested that perhaps these 
flights have their source in the large amount of breeding taking place 
in the patches of Cftara in the lake area, probably in the nature of 
periodic or seasonal "dispersal" flights. Certainly the time of the 
flights corresponds with the time of optimum breeding conditions in 
the lake. 

Moreover, the increase of Anopheles breeding in lake areas has a 
direct bearing on the question of the "Zone settlers" who have been 
permitted to occupy every available piece of land suitable for banana 
raising on the shores of Gatun Lake. When the traffic through the' 
Canal becomes so great that night transits are necessary, these settlers 
will have become such a source of infection with malaria that the prob- 
lem will have to be dealt with either by depopulation or by sanitation 
at a cost that now seems prohibitive. 

The influence of Zone settlers on the occurrence of malaria in per- 
manent Canal Zone towns, Army stations, and the city of Colon, all 
located in the area north of Gatun, was discussed briefly in the annual 
report for 1930. Further studies of the situation were made and the 



33 

results of these studies and recommendations incident thereto are 
incorporated in pages 56 to 59 of this report. 

Pending permanent solution of the problem of Zone settlers, the 
Health Department is continuing frequent blood surveys of certain 
groups of the settlers and treatment of those found to be infected. 

Special projects, northern district. — The work of the northern dis- 
trict, so largely composed of tidal swamps and marshes of vast extent, 
is now largely one of maintenance. Considerable attention has been 
given to the study of the mosquitoes breeding in some of the nearer 
undrained areas, as in tl* Mojinga swamp of the lower Chagres River, 
but no breeding areas of Anopheles albimanus of such extent as to merit 
concern have been discovered. The Medical Department of the Army, 
which maintains sanitation in the immediate vicinity of the Army posts, 
has continued extending the drainage east of Fort Randolph as far as 
the Zone boundary line, chiefly for the control of Anopheles tarsi- 
maculatus (variety aquasalis). 

Special projects undertaken in southern division — Pedro Miguel, 
Ancon-Balboa, and Panama suburban districts. — In addition to the 
usual maintenance and control work done in this area, the inspector 
in charge of the division and his subordinates furnished personnel and 
material to assist in the experiments with airplane dusting (see pp. 59 
.to 64), and undertook the malaria control work in the Madden Dam 
area. 

The construction of the Thatcher Highway, extending from the 
west side of the Canal at Balboa to the Zone boundary at Arraijan, has 
opened up a new area to which employees will have access, including a 
swimming beach at the mouth of the Farfan River. Considerable 
drainage will need to be installed in the vicinity of the road proximal 
to Balboa. 

The large mangrove swamps along the west bank of the Canal, which 
formerly were inundated daily by the tides, are being filled by a hydraulic 
dredge and will require sanitary control where none was needed before. 
At the present time these areas contain large pools of fresh or brackish 
water into which it is impossible to venture because of the bottomless 
mud underlying them. The tangled roots of mangrove (Rhizophora 
mangle) preclude the use of boats. With the advent of the rains an 
attempt will be made to control mosquito breeding in these swamps 
(Anopheles and Aedes taeniorhynchus) with fuel oil sprayed from an 
airplane by Lieut. R. T. Zane of the Army Air Corps, Aeronautical 
Aide to the Governor of the Panama Canal, who has for some months 
been experimenting with a small equipment designed by himself for 
this purpose. In areas such as that described above and where 



56 

culcines other than Anopheles are to be dealt with, the proposed 
method seems to offer perhaps the only practicable means of control. 

MALARIA IN COLORED SETTLERS (FARMERS) LIVING IN THE CANAL ZONE. 

In 1921-1922 the policy was adopted of permitting individuals to 
rent limited areas of land in the Canal Zone for farming purposes for 
the reasons set forth below: 

(a) On completion of the Canal a large reduction in the number 
of employees was necessary. Many colored laborers (West In- 
dians) were left without employment andithe opening of the Zone 
to settlement as an emergency measure would relieve the unem- 
ployment situation and the congestion of population in Panama 
City and Colon. 

(b) It was assumed that the settlers, through their farming ac- 
tivities, would materially increase the supply of fresh vegetables, 
fruits and other foodstuffs for local consumption. 

(c) It was thought that these settlers would provide a reservoir 
from which adequate numbers of laborers could be drawn to meet 
special or emergency conditions. 

The first of the above intentions, that of relieving unemployment 
and congestion of population was accomplished to some extent. 

But little has been accomplished in supplying fresh vegetables and 
fruits for sale except bananas, and changes in soil content are adversely 
affecting this latter industry in the lake region. As a result of rapid 
increase in the population of Panama City an adequate reserve of 
labor is available. At the present time (1931) these so-called "Zone 
settlers" number about 4,200. They live in various parts of the Canal 
Zone but are not permitted to build houses and live on land within one 
mile of permanent Canal Zone settlements or military stations. The 
principal settlements are located as follows: An area known as the 
Chiva Chiva trail to the east of Fort Clayton, with a population of 713 ; 
the Pedro Miguel valley to the north of Pedro Miguel, population 190; 
the area along the Gaillard Highway between Gamboa and the Ex- 
perimental Gardens at Summit, population 149; Frijoles (a station on 
the Panama Railroad) in the Gatun Lake region, population 848; the 
Loma Bracho — Chagres River basin — Gatun area, population 284; 
and more or less isolated farms on the shores and islands of Gatun 
Lake, population 1,295. 

This group of the population of the Canal Zone has greatly increased 
the amount of malaria and other diseases in the Zone. 

It can be assumed that the present population will increase gradu- 
ally even though no additional land licenses are granted, and eventually 



57 

the result will be that the Panama Canal Government will be faced 
with the problem of a large rural population consisting of aliens, with- 
out nearby schools, physicians, or sanitation, unless the Government 
is prepared to furnish these at great cost. 

From the viewpoint of hospitalization alone these settlers already 
have become a problem for the Health Department. 

As a rule the amount of produce raised permits them to eke out only 
a bare existence and but few of them can pay the nominal fee of from 
50 cents to $1 per day charged for hospitalization. During the calen- 
dar years 1930 and 1931 the total amount of hospital charges against 
these settlers (at the rates mentioned above) was $5,881.95. Of this 
amount only $1,343.04 or 23 per cent has been collected. 

The principal interest of the Health Department in the situation is, 
however, a much broader one, namely, that of sanitation and malaria 
control. If the Canal Zone is to remain somewhat thickly settled with 
a resident population of this type, or is to become more densely settled 
with the natural increase that will occur, it may be anticipated that, to 
protect this class of residents, Panama Canal employees, military 
forces, and shipping from malaria and other acute transmissible diseases 
common to the Tropics, it will be necessary to extend routine disease 
control measures to all inhabited parts of the Zone. At the present 
time comparatively small areas of the Canal Zone — those in the vicinity 
of permanent Canal Zone settlements — are intensively sanitated against 
malaria. The magnitude of the problem can be appreciated when it 
is understood that Gatun Lake covers an area of 165 square miles with 
much over 1,000 miles of shore line and that, in addition, 300 square 
miles of land area are involved. 

The area in which malaria rates in Canal Zone employees, military 
personnel and others are most seriously affected by Canal Zone settlers 
is that north of the Gatun Locks in which are located the towns of Gatun 
and Colon, several military stations (Fort Davis, Fort Sherman, Fort 
Randolph, and France Field) and the Naval station, Coco Solo. The 
malaria problem in this area was reported to the Governor in 1930 
and pending further study he directed that no additional licenses 
be granted in the area ; that no transfers of licenses would be permitted, 
and that licenses would be cancelled when practicable (see pp. 80 and 
81, Annual Report, 1930). 

This problem was given special consideration during 1931 by a 
Health Department committee consisting of Dr. D. P. Curry, Assist- 
ant Chief Health Officer; Mr. \Y. H. W. Komp, Sanitary Engineer, 
U. S. Public Health Service; and Maj. Geo. C. Dunham, Medical 
Corps, U. S. Army, and the committee made the following recommen- 
dations: - 



58 



(n) The committee recommends that the Loma Bracho area, the Chagres River 
basin below the spillway, the shore of Gatun Lake to a distance of three miles south 
of the spillway, and the Majagual and Escondido areas east of Margarita Road 
be depopulated of the so-called Zone settlers by the revocation of licenses and pur- 
chases of improvements. It were better that not even agricultural operations be 
be permitted in these areas, as the Anopheles albimanus, one of the most potent 
carriers of malaria, breeds best and almost exclusively in water well exposed to the 
sun. Therefore, operations involving clearing of the land favor the incidence of 
malaria. 

(b) It is further recommended that, if it becomes practicable by reason of construc- 
tion of a highway along the Panama Railroad beyond Gatun, the "banana dock" 
at Gatun Lake be removed to a point at least one mile from the town so as to remove 
the considerable number of natives who regularly congregate at night at this point 
en route to and from settlements on Gatun Lake. 

(c) It has long been the policy of those engaged in malaria control work on the 
Isthmus to utilize the maintenance and control gangs during the dry season for the 
further extension and improvement of the regularly sanitated areas. This policy 
should, of course, be continued, as it is believed that by reason of it in the past the 
Zone as a whole has arrived at and maintained its really excellent results in the 
reduction of malaria. 

The report of the committee was concurred in by the Chief Health 
Officer and submitted to the Governor for consideration. It was 
referred by him to a general committee consisting of the Chief Health 
Officer, the Auditor, the Executive Secretary, and the Land Agent, 
Panama Canal, with directions that recommendations be made as to 
the disposition of the settlers should depopulation be carried into effect, 
the source from which funds could be obtained to cover reimburse- 
ments for improvements and transportation charges for repatriation, 
and the time limits that should be set for accomplishing depopulation. 

The committe found that no funds were available and recommended 
that they be secured from Congress. 

This recommendation was approved by the Governor and funds to 
carry it into effect will be requested of Congress when economic con- 
ditions warrant their inclusion in the budget. In the meantime special 
efforts are being made to reduce the number of settlers throughout the 
Zone by cancellation of licenses. That some results are being obtained- 
is evidenced by the following data showing number of licenses in effect 
as of June 30 for the years 1922 to 1931 : 





Fiscal years — 




1922. 


1923. 


1924. 


1925. 


1926. 


1927. 


1928. 


1929. 


1930. 


1931. 




1,026 
7.6 


1,805 
9.1 


2,154 
7.8 


2,112 
8 3 


2,012 
8.9 


2,019 
8.3 


2,041 

7 7 


2,123 
6.9 


2,102 
6.8 


1,927 




6.3 



59 

During this year the policy was continued of making monthly blood 
surveys for malaria of the agricultural population living in the vicinity 
of permanent Canal Zone settlements and military stations and treating 
with quinine the individuals having malarial parasites in the blood. 

A few interesting facts have been disclosed by these surveys, namely : 

(a) There are two small villages, Frijoles and Monte Lirio, on 
the Panama Railroad in the lake region in which no malaria con- 
trol measures are carried out except as is indicated below. 

In one of these small villages, Monte Lirio, the habitations are 
adequately screened. One survey was made of this population 
(total 24, of which 14 were examined) in 1931 and the average per- 
centage of individuals carrying malarial parasites was 7.1 per cent. 

In the other village, Frijoles, the houses are not screened and 
the comparable average percentage carrying malarial parasites 
for the five surveys averaged for 144 individuals, 16.3 per cent. 

(b) Eight surveys were made of the inmates and police guards of 
the Canal Zone penitentiary at Gamboa (average population 69; 
average number examined 58) and the average malaria infection 
rate found was 1 .5 per cent. The institution is effectively screened 
and the prisoners must of necessity remain indoors during the 
night. 

(c) The blood survey rates for malaria in the population living 
on the fringes of the areas in which intensive malaria control work 
is constantly being done were considerably lower than the rates 
prevailing in representative samples of the population in the lake 
region : 

Chiva Chiva trail, scattered rural, mostly Afro- West Indians 10.0% 

Pedro Miguel valley, scattered rural, mostly Afro- West Indians.. 3.9% 

Escobal, native village, Gatun Lake 19.7% 

Limon, native village, Gatun Lake 22.2% 

Observations similar to those recorded under (a) and (b) above have 
been made in this region for many years, namely, that adequate screen- 
ing of houses occupied by humans, of itself alone, constitutes a 
most important measure in malaria control work. 

MOSQUITO BREEDING AREAS IN THE VICINITY OF PANAMA CITY, AND 
THEIR CONTROL BY DUSTING WITH PARIS GREEN FROM AIRPLANES. 

In mosquito control work on the Isthmus it has been the policy of 
the Health Department, for many years, to rely principally on perma- 
nent drainage work. In some situations (along the shore line of the 
lakes supplying water for the Miraflores Locks) it has been the custom 



60 

to use oil applied as a spray from boats. In this particular situation, 
this method of control is the most efficient and satisfactory that can 
be applied on account of the low cost of oil and the fact that mosqui- 
toes which constitute a pest, as well as anophelines, are controlled. 

During recent years the city of Panama has been gradually extending 
eastward along the shore line, and suburban areas are being developed 
along the highway extending from Panama City to Chepo (Pueblo 
Nuevo, San Francisco de la Caleta, Juan Diaz, Pacora). The area 
between the city proper and Juan Diaz is now quite thickly settled. 
During the year a blood survey of representative samples of the popu- 
lation living in this area was made by malaria control units of the 
Health Department of the Republic of Panama under the direction of 
Dr. Paul F. Carley of the Rockefeller Foundation, and showed that 
from 12 to 43 per cent of the population carry malarial organisms. 
Surveys repeated at frequent intervals would show a much higher 
actual rate of infection. It also was noted that as the distance from 
Panama City increased the malaria infection rate increased. 

The improved highway from Panama to Chepo runs along the foot- 
hills and between it and the sea is a strip of lowlands (marshes and 
swamps) from one to about three miles in width that becomes inun- 
dated with brackish or fresh water during the season of rains (May 
to December). 

This area, 40 or more miles long and from 1 to 3 miles wide, 
affords ideal breeding conditions for many species of mosquitoes and 
particularly for Anopheles albimanus, the most important malaria 
transmitter in this section, and for the Aedes taeniorhynchus , the out- 
standing nondisease bearing mosquito pest on the Isthmus, from May 
to about August. The Aedes taeniorhynchus breeds in enormous num- 
bers in the coastal marshes mentioned above and at certain times large 
numbers are observed in Panama City and the Zone that undoubtedly 
have made sustained flights from marshy areas 10 to 20 miles or more 
distant. It has been observed that the initial flights, presumably 
nuptial, as a large proportion of males was present, are infinitely larger 
some years than others. In 1931 one of these enormous flights occurred. 
On the night of June 9, 1931, about 7 p. m., myriads of these mosquitoes 
suddenly appeared in all parts of Panama City, Ancon, Balboa, and 
elsewhere on the Pacific side. At the time of their appearance a 
young people's meeting was being held in the Baptist church (un- 
screened) about 200 yards from the Panama Canal administration 
building, Balboa Heights, and their swarming myriads caused the 
adjournment of the service. The following morning thousands were 
observed resting on the walls and ceilings of the adminstration building 




All 61. 5hce+ing Fxcepf- 5i/ppcrfir>g F/anye. 



Cut No, 3, — Hopper for carrying mixture of dust and Paris green, with mechanism for releasing the 

mixture. 



61 

(unscreened), particularly on the third floor. There were hundreds 
of dead males on the inside sills of the closed windows of the Baptist 
church. Part of the same flight made its way inland as far as the 
Madden Dam area, not nearer the coastal swamps than 20 miles. 
This flight came from the coastal swamps east of Panama City, certain- 
ly from 15 to 20 miles or more distant from Balboa. A second large 
flight (considerably smaller than the first) occurred several days later. 

In checking back on similar flights it was found that the last one of 
like proportions occurred in 1927 and curiously enough the flight that 
year was on the night of June 10, whereas the one in 1931 occurred on 
June 9. The control of this pest is impracticable under existing con- 
ditions. It has been possible, however, gradually to extend drainage 
projects in this area and during the past few years the marshy areas 
from the city proper to Old Panama have been drained, chiefly for the 
control of Anopheles albimanus however. 

Between Old Panama and Juan Diaz there exists a low marshy area, 
from one to two miles in width and four miles long, which is used for 
pasturing cattle. The Health Department has been observing mos- 
quito breeding conditions in this area for a number of years and it is 
known that at times each year Anopheles albimanus breeds prolifi- 
cally there. In 1931 consideration was given to the possibility of 
preventing Anopheles breeding in this area. Estimates based on sur- 
veys indicated that the installation of a drainage system would cost 
about $25,000. There was also some question as to whether a drainage 
system could be installed without the use of tidal gates. Assuming 
that the drainage system could be installed, the maintenance costs 
would be very high. This project was therefore abandoned as being 
impracticable. 

Consideration was then given to the feasibility of controlling An- 
opheles breeding by the use of Paris green dust, distributed by air- 
plane. The matter was broached to Lieut. R. T. Zane, Aeronautical 
Aide to the Governor, and he considered it feasible. The experiments 
we had in view were heartily approved by Maj. Gen. Preston Brown, 
Commanding General, Panama Canal Department, and his cooper- 
ation was secured. He very kindly directed the Air Corps to co- 
operate with us by furnishing airplanes for the experiments. 

A hopper with mechanism for releasing the mixture of dust and Paris 
green, easily installed and quickly removable from the afrplane, was 
constructed after the design of one used by the United States Marine 
Corps in dusting with Paris green the shores of Lake Managua in 
Nicaragua, photographs and descriptions having been furnished by 
Lieut. Commander J. F. Neuberger, Medical Corps, U. S. Navy, who 



62 

was in charge of the work there. It was found essential to install an 
agitating device, actuated by a small wind-driven propeller, in the 
throat of the hopper to insure a uniform feed of the dust mixture; also 
the controls were changed to permit them to be operated from the 
pilot's cockpit. These changes added much to the efficiency of the 
apparatus. 

A plane of the bomber type was selected, as large amounts of Paris 
green mixture could be carried, and the equipment could be installed 
or removed in about 15 minutes without modifying the structural 
features of the plane. Paris green of the proper quality was quickly 
made available through cooperation on the part of Dr. Paul F. Carley, 
of the Rockefeller Foundation. A clay somewhat similar to fire clay 
that, when dried, was easily pulverized into a fine dust, was found to 
be available on Diablo Hill about one mile from Balboa. 

The area to be dusted was and still is being used as a cattle pasture 
and during the rainy season is trampled into a quagmire; the innumera- 
ble water-filled depressions afford ideal breeding conditions for A. 
albimanus and other species of mosquitoes.- It is covered with Para 
grass and aquatic plants from one to five feet in height and it was felt 
that the first step should be to determine the concentration of Paris 
green that would be required to assure that it would filter down through 
the vegetation and kill the Anopheles larvae. 

The effectiveness of the dusting in this experimental work was 
checked by placing flat, white enameled developing trays containing a 
small amount of water and known numbers of A. albimanus larvae on 
the ground in representative parts of the area. 

On July 10, inspection of the area showed profuse Anopheles breed- 
ing and the first experimental dusting was done on July 17; 600 
pounds of Paris green and dust mixture (Paris green 20 per cent, dust 
80 per cent, by weight) was used per trip and two trips were required 
to dust the entire area. The dusting material was loaded into the 
plane at the Panama National Airport, Paitilla Point, about two miles 
west of the ruins of Old Panama. The area dusted is approximately- 7 
miles east of Balboa. The time required for each flight was only 15 
to 20 minutes, actual dusting operations requiring 10 to 12 minutes. 
The altitude maintained during dusting operations was from 100 to 200 
feet. 

At present the bombers are located at France Field on the Atlantic 
side and the total time required for the flight across the Isthmus, load- 
ing and making two flights over the area dusted and returning to base, 
is about two hours. 



63 

Inspection after the first dusting showed from 80 to 90 per cent of 
the larvae in the trays used as controls were killed and the results in 
the area itself appeared to be even better. 

The second dusting was done July 28, under the same conditions as 
the first, 86 per cent of the larvae in the trays being killed. 

A third dusting was carried out on August 4, under the same condi- 
tions as for the first two dustings except that the concentration of Paris 
green in the dusting mixture was reduced from 20 to 16 per cent, the 
amount of mixture used for the two trips being increased from 1,200 
pounds to 1,500 pounds. Approximately 80 per cent of the larvae in 
the trays were killed. 

The experiment was repeated September 11, under the same condi- 
tions as previously, except that the Paris green in the dusting mixture 
was still further reduced to 10 per cent, the total amount of the mixture 
being increased to 2,400 pounds. The results obtained were even 
better, owing probably to better distribution of the Paris green. Fur- 
ther control checks (distribution of trays containing definite numbers of 
larvae) were considered unnecessary. 

Weekly inspections of the area for breeding were continued and it 
wasnecessary to dust by airplane again on December 18; 2,400 pounds 
of the mixture, 10 per cent Paris green, being used, the same as on Sep- 
tember 11. No living larvae could be found in the marsh on the fol- 
lowing day. 

The method of control gave excellent results in this area and it is 
the intention to continue it during 1932 and possibly extend it to a 
special area on the west side of the Canal near Balboa where a temporary 
artificial breeding area has been created by dredging operations in 
connection with the construction of the Thatcher Highway. 

The costs of Anopheles control in the area dusted (about one and 
one-half miles in length by one mile in width), exclusive of cost of 
airplane service which was furnished free of charge by the Army as 
a cooperative measure, were as follows: 

Capital charge: 

Equipment (hopper and attachments) .„.. $385.59 

Operating charges, based on work required to accomplish one dusting of the area 
by airplane: 

Inspection of area for breeding 18.68 

Paris green, 240 pounds at $0.2154 per pound 51.70 

Dust, dried and delivered at Ancon, 2,160 pounds at $0.005 .. 10.80 

Mixing dust and Paris green 4.40 

Loading, transporting, and delivery of mixture at airport 10.80 

Total operating charges, exclusive of airplane service and interest 

and depreciation on equipment 96.38 



64 

Observations of breeding conditions in this area indicate that a mini- 
mum of 7 to 10 dustings each rainy season, at weekly intervals, will be 
required to control Anopheles breeding An annual operating charge 
of between $660 and $960 to control this area is quite reasonable when 
it is considered what the construction and maintenance of a permanent 
drainage system would cost. 

It is proposed to carry on some experiments during 1932 in spraying 
oil from airplanes. 

DRAINAGE WORK. 

For the benefit of antimalaria workers who have drainage problems 
similar to our own, the following detailed information regarding our 
various forms of concrete paved ditches is given : 

The "double decker" drain is used chiefly in small streams that have 
a dry season flow from springs, this residual water being carried in 
6-inch tiles placed immediately beneath the semicircular concrete 
inverts in which the storm water flows. The excavation for this drain 
is made as shown in Cut No. 6. But one size of pipe (6 inches inside 
diameter, 1 foot in length) and one width of semicircular invert 
(14 inches wide, 6 inches deep, inside measurement) are used. In 
deep cuts the earthen sides of the drain are sodded above the invert 
(Cut No. 6). There is, of course, only occasional need for such double 
drains. Ordinarily we use either the subsoil tiles or the concrete 
inverts alone. For very steep grades in which there is little or no 
danger of water standing in the ditch, even when slight obstructions 
are present, the open sections are preferred in place of subsurface tiles, 
as being less apt to be washed out by flood water. Where the terrain 
does not permit of more than 0.3% grade, the open sections are usually 
more satisfactory, as being easier to free from silt; for seepage only, 
subsurface tile is installed at any or practically no grade if necessary. 

Cut No. 7 shows the machine uses for making the 6-inch by 
1-foot concrete tiles. The machine is operated by hand; to insure 
uniformity, the fairly dry concrete mixture is made with the small 
gasoline mixer shown in the photograph. These 2 men make 400 
pieces of tile in 1 day at a cost of about 4^ cents each. After stand- 
ing overnight on the drying racks, the tiles are next day placed under 
water in the shallow tanks shown in Cut No. 8 to cure for 24 
hours. They are then stacked in the open until needed. These tiles 
are made only in the rainy season and they gain considerably in strength 
during the 6 months or more of exposure to the rains. 

The sectional inverts are made as shown in Cut No. 9. 
The 2 men make 60 to 70 sections in 1 day at a cost of 48 cents 



i.VdMI'I'Hm 




,dUMMMlMlL 






. or os ,/£ 
required ' //g; 
<9">F^ by grade ^ 



_ l> v 



%^#/ 



3t" 3^" 3L" 19" 17' 



i\ 10" 




Cut No. 6. 

a. — "Double decker" drain with grassed sloping hanks. (See page 64.) 

b. — Shallow excavation for laying a "double decker." (See page 64.) 

c. — Arrangement of side bars and separators (pallets) for casting alternately 

right and left curve sections. (See page 65.) 
d-e-f. — Method of laying curves of various radii. (See page 65.) 




CUT No. 7.— Machine for making 6" x 1' concrete tile. The two men make 400 pieces per day "I 
8 hours. 




Cut No. 8 —After standing overnight on the drying racks, the tiles are next day placed in the shallow 
tanks (foreground) to cure for 24 hours under water. They are then stacked in the 
open until needed. 




CUT No, 9. Tables for easting sectional concrete inverts; the usual size is 36" long. 14" wide (inside 
measurement. J 



65 

per section. The usual procedure is to make the 6-inch tiles every 
other day, and sections the alternate days, so as to leave the sections 
in the forms for 36 hours or more after pouring them. The semi- 
circular core is made from galvanized sheet iron 1/16 inch thick, and 
bent to nearly a half-circle with a 7-inch radius. The side bars are 
of steel, 3 inches wide, | inch thick, and 3 feet long. A f-inch space 
is left between the ends of each pair of bars where they are bolted 
together and to the table by means of a cast clip-angle. Into this 
slot-like space fit freely the sides of the bronze pallets, or separators, 
which divide the cast sections and give form to the male and female 
end of each section. The sections are laid without cement, the male 
end fitting easily into the female end. The straight sections are all 
3 feet long, but provision is made for laying smoothly jointed curves 
by casting some sections with one side shorter than the other. These 
irregular sections are cast on the same straight core by making alter- 
nate ones right or left curves (Cut No. 6). By varying the length 
of these irregular sections the curves can be made of varying radius. 
Thus, a section 36 inches long on one side and 34 inches on the opposite 
side, will lay exactly a curve of 27 feet radius; half-size sections 
(19 inches one side, 17 inches other) will lay a curve of 14 \ feet radius; 
^-size sections (12 inches one side, 10 inches other) will lay a curve of 
9 feet radius (Cut No. 6). By slightly opening the joint in the 
inner or outer side between two sections, the degree of curvature may 
be varied to any required degree. 

Near one end of each of the shorter sections, and at both ends of the 
longest sections, are placed wire loops (see Cut No. 9, front end of newly 
cast section at right). These wires are used to pry or lift the sections 
from the core after setting, and they also facilitate their handling on 
the wheel-carriage (Cut No. 9 left) and in the field. 

The sections are made with Portland cement, sharp sand, and gravel 
or broken stone, in the standard 1-2-4 mix (machine mix). After 
hardening in place for 24 hours they can be removed and stored on end 
out of doors. (Cut No. 8, right background). To remove from the 
form, the weights (short pieces of railroad steel) are removed, the 
long wooden sideboards lifted, and the endmost pallet tapped loose 
and taken out of the slots. The front section can then be pried loose 
and lifted off the table, later to be carried out on the 2-wheeled cart. 

In laying these sections in the field the area to be drained is first 
carefully surveyed, the levels being determined by a surveyor's level 
(in the use of which the sanitary inspectors are proficient). The 
natural grades and the proposed grades are carefully plotted on 

MR 31053 5 



66 

profile paper and the utmost care is taken to secure a neat-appearing 
workmanlike job. Batterboards are set at 50-foot intervals. Since 
the grade is often as slight as 0.1% (1 foot in 1,000) the elevations are 
read closely with the level. The depth of cut may be determined from 
a tightly stretched cord, but the final laying of the concrete paving is 
done by measurement from a taut steel wire. The distance from the 
wire to the bottom of the invert is measured off on a smooth hard stick 
(a broom handle does nicely) and a slight nick is made at such a dis- 
tance from one end that when the invert is at the proper point the 
nick just fits on the stretched wire. Before backfilling is done at the 
sides of the sections they are aligned carefully by observing them from 
a suitable distance so as to determine if the tangents are straight and 
the curves gracefully made. A little extra attention to this detail 
greatly improves the appearance of the completed drain. 

Reference to page 6 of our annual report for 1919, will show the 
type of precast concrete inverts used up to 1928; this has a large bell 
end which necessitated extra excavation at the end of each piece. 
The concrete inverts now used, as shown in these illustrations, have 
an unbroken straight surface on the botton and sides, and are vastly 
easier to lay. When the sections were cast in the old way, each section 
in a separate form, the inside finished by troweling, it was practically 
impossible to get them of even thickness and shape, so that consider- 
able labor was required to get them laid to an even and continuous 
grade. The continuous core with cast separators for the sections as 
now made, insures uniformity so that the male and female ends inter- 
lock without the least difficulty. 

TRYPANOSOMIASIS IN ANIMALS. 

In the annual report for 1930 (pages 78 and 79) the occurrence of 
trypanosomiasis (murrina) in animals was discussed. Cooperative 
work on the part of the Gorgas Memorial Institute, the Army, the 
Supply Department and the Health Department of the Panama 
Canal, and the Panamanian Government was continued during 1931 
and the Gorgas Institute has made important contributions to our 
knowledge of the disease. 

No epidemics occurred in horses or mules on the Canal Zone during 
the year. Occasional cases (13) have been found in horses belonging 
to colored farmers on the Zone and the history of the animals involved 
indicates that infected animals were brought into the Zone from in- 
fected areas in the Republic of Panama. 

During the year blood film surveys of horses and mules were made 
throughout the Canal Zone and along the highways in the Republic 




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67 

of Panama on either side of the Canal Zone extending to the east as 
far as Chepo (42 miles) and to the west as far as Aguadulce and Las 
Tablas (about 200 miles). Only 29 cases were found in these areas and 
they were distributed as follows: 

Summit, Canal Zone 3 Pacora to Chepo, Republic of Panama 12 

Chiva Chiva, Canal Zone 5 Aguadulce to Las Tablas, Republic of 

Hooper Farm (Gatun, C. Z.) 1 Panama 4 

U.S. Army, Fort Davis (Gatun, C. Z.) 4 

The Army animals apparently contracted the disease during ma- 
neuvers. 

The present foci of the disease are in the provinces of Code, Herrera, 
and Los Santos, Republic of Panama, which lie to the west of the Canal 
Zone, and in the Province of Panama, 30 miles southeast of Panama 
City, in the sabanas. 

The epidemiological evidence already secured indicates that with 
the extension of good roads from Panama to Chiriqui Province (which 
is the border province next to Costa Rica) the disease is extending. 
The disease has not as yet reached Chiriqui Province, but doubtless 
will do so in the near future. 

During the year, through cooperation on the part of the Panama 
Canal, it was possible for the Gorgas Memorial Institute to establish 
a research veterinary station on the west side of the Canal at Miraflores. 
This has made possible considerable expansion of the investigation of 
trypanosomiasis by the Gorgas Memorial Institute. As a result of 
the experimental and other work done by the staff of that institute, 
much important information has been added to our knowledge of the 
disease. 1 The most important points maybe summarized as follows: 

1. If an infected herd is surveyed (clinical examination plus 
blood survey) and all infected animals placed in isolation two miles 
or more distant from the uninfected herd, it appears that the 
disease can be eliminated, provided several resurveys are made 
at short intervals (three to four days) and the occasional supple- 
mentary case removed. 

2. The disease can be transmitted to guinea pigs, rabbits, and 
other lower animals but the duration of life after infection is short 
in such animals. 

3. The parasite occurs in nature in cattle and can be trans- 
mitted. In cattle the infection does not cause any appreciable 
symptoms but they provide a dangerous reservoir. 

■Dunn, L. H. — Experiments in the transfer of Trypanosoma hip picum Darling with the Vampire 
Bats. Jour. Prev. Med., 6, Sept., 1932. 



68 

4. The disease can be transmitted from animal to animal by 
vampire bats (Desmodus rotundus murinus Wagner) and the evi- 
dence indicates that the mechanism of transmission is a biological 
rather than a mechanical one. 

5. The fact that cattle can become infected without symptoms, 
thus acting as reservoirs for the spread of infection, makes the 
problem of control a most difficult one where equines and bovines 
occupy the same range. In this respect the trypanosomiasis 
(murrina) of the Isthmus parallels that (surra) of the Philippine 
Islands. In this region cattle are reservoirs; in the Philippines, 
carabao. More details regarding 4 and 5 will appear in later 
publications by the Gorgas Memorial Institute. 

The quarantine against the transfer of animals from the west to the 
east side of the Canal, in the Gatun area, has been continued in force 
throughout the year. Recent surveys of animals in the quarantined 
area have failed to disclose any infected cases. If repeated surveys- 
continue to show absence of infection, it is planned to raise the quar- 
antine in 1932. 

EXPERIMENTS IN COMPOSTING MANURE. 

In the Annual Report for 1930 (pages 79 and 80) the methods of 
disposal of manure to prevent fly breeding were discussed. The 
results of some experiments, including a modification of the existing 
system, were recorded. Further experiments during 1931 indicate 
that if the manure is sealed tightly in concrete pits for a period of one 
week, then ventilated and oxygen is allowed to circulate freely through- 
out the mass for a period of from two and one-half to three weeks, 
the resulting humus has appreciably less odor, is not so attractive to 
Musca domestica (the house fly) as is raw manure, but still retains its 
attraction for Stomoxys calcatrans (the biting stable fly). The result- 
ing humus apparently does not reach the advanced stage of decom- 
position reported in certain garbage disposal plants in the United 
States and in Italy for the so-called Beccari system for the disposal of" 
garbage. Some experiments were undertaken with mixtures of repre- 
sentative samples of garbage and manure with unsatisfactory results. 
Further experimentation has been discontinued for the time being. 

DISPOSAL OF GARBAGE, PACIFIC ENTRANCE TO THE CANAL. 

It was pointed out in the 1930 annual report that for a number of 
reasons it would be necessary, in the immediate future, to abandon 
the present method of disposal of garbage for the communities located 



69 

at the Pacific terminus of the Canal (Panama City, Ancon, Balboa, 
Quarry Heights, and Fort Amador). 

During the year a thorough study was made of the various possi- 
bilities and disposal by burning in an open grate incinerator was 
decided upon as being the most economical and practicable at the 
present time and under existing conditions. The incinerator is to be 
located near Summit, 12 miles north of Panama near the main line of 
the Panama Railroad. 

HEALTH SERVICES IN THE TWO TERMINAL CITIES, COLON AND PANAMA. 

The Health Department, Panama Canal, maintains health services 
in the cities of Panama and Colon the principal activities of which are: 
To prevent the occurrence of epidemics of diseases that might interfere 
with or tend to delay the transit of shipping; to enforce such health 
regulations as will reduce to the lowest minimum practicable the 
occurrence of diseases prevailing in this section, of which malaria is an 
example; and to reduce the prevalence of the insect transmitters of 
such diseases as yellow fever and plague to such an extent that even 
if introduced on the Isthmus their spread would be either markedly 
curtailed or would be impossible. The scope of the health work done 
in the cities of Panama and Colon by the Health Department, Panama 
Canal, the activities carried on by the Health Department, Republic 
of Panama, costs of such work to the Panama Canal and conditions 
(treaty agreements) under which the work is done, were summarized 
briefly in the annual report for 1930 (pages 82-84). 

REPORT OF THE HEALTH OFFICER— PANAMA. 
Dr. Jesse L. Byrd, Health Officer. 

The proposal to coordinate better the health services rendered by 
the Panama Canal and the Republic of Panama in Panama City, 
mentioned in the report for 1930, was taken under advisement when 
the new government came into being in January, 1931. An agreement 
tentatively acceptable to both parties, has been evolved and has now 
reached the stage of translation of final draft. 

In Panama City it has been the practice until recently, to permit 
adjoining buildings to leave a space of from 2 to 12 inches between the 
adjacent walls. This practice was not only contrary to the building 
regulations, but provided many additional rodent propagating areas. 
The present practice provides for the elimination of all unnecessary 
spaces which might provide rat harborage. We are sometimes handi- 
capped in trying to provide adequate ventilation for tenement rooms 
and in some apartments by an old Panamanian law which prohibits 



70 

the opening of a window that faces another owner's property if the 
walls of said building are located on the property line. Since most of 
the houses in the older parts of the city are located on property lines, 
this law prevents many owners from securing adequate light and ven- 
tilation for their houses. However the present policy of limiting the 
coverage to 80 per cent of the building area or lot, and using 20 per 
cent of such space to the best advantage in distributing light and 
ventilation has proved satisfactory. 

There were 1,008 building permits issued as follows: 

New buildings 78 

Repairs and alterations to existing buildings 258 

Miscellaneous repairs 647 

Installation of fixtures and counters, and rat-proofing same 25 

The building inspector makes numerous follow-up inspections on 
all permits issued, to insure compliance with the sanitary and building 
regulations. 

There were 1,965 rats and 2,456 mice caught in the city during the' 
year; 3,978 were forwarded to the Board of Health Laboratory for 
examination and were classified as follows: 

Mus musculus. 1 ,986 

Mus alexandrinus. 52 

Mus norwegicus 216 

Mus rattus 1 ,724 

Dairy and milk inspection. — There are 23 dairies supplying milk to 
the city, a small part being sent to the Canal Zone and Colon. These 
dairies contain 2,724 animals; 37 dairy cattle and calves were imported 
from the United States and 190 head from Costa Rica during the year. 
All dairy cattle including importations were tested for tuberculosis 
during the year, 66 giving a positive reaction. All reactors were 
slaughtered. The total milk production during the year was approxi- 
mately 450,000 gallons or 2,250,000 bottles of 1/5 gallon each. 

There has been an improvement in the handling of milk by milk 
vendors. Practically all pasteurized milk is being kept properly cooled 
and the practice of selling splits or parts of a bottle is gradually being' 
eliminated. There is no bulk milk sold and dipping is prohibited. 

All dairies and pasteurization plants receive weekly inspections and 
samples are taken monthly for laboratory examination. 

Ice cream. — The regulations require the pasteurization of the mix, 
and a minimum of eight per cent butter fat. These plants are required 
to keep their places scrupulously clean and in proper sanitary condi- 
tion at all times. They are given a thorough inspection at least once 
a week. 



71 

Soft drinks. — There are four bottling plants in the city. Each plant 
is equipped with modern machinery, such as mechanical bottle washers 
and automatic bottle filling and capping machines. These plants 
receive frequent inspection to insure the purity and cleanliness of their 
products. 

General food inspection. — Restaurants, hotels, clubs, markets, can- 
tinas, ice cream and solf drink parlors, stores and all other places where 
food is prepared, manufactured, stored, sold or offered for sale, receive 
frequent inspections in order to insure their maintenance and opera- 
tion in proper sanitary condition and that all products therefrom are 
sound, pure and wholesome. 

The following plants are given frequent inspection: Municipal 
markets, 2; private markets, 67; bakeries, 16; bottling plants, 4; brew- 
eries, 2; clubs, 3; ice cream plants, 4; ice cream parlors, 30; soft drink 
vendors, 33 ; hotels, 7 ; restaurants, 64. 

Meat inspection. — At the municipal abattoir, 13,875 cattle were given 
ante and post-mortem inspections; 58 were condemned as unfit for 
food on account of the following conditions: Natural death, 24; ex- 
tensive bruises, 15; septicemia, 3; emaciation, 1; pneumonia, 2; as- 
phyxia, 1 ; tuberculosis, 7 ; congestion, 3 ; hepatitis, acute, 1 ; sapremia, 1. 

There were 15,846 hogs slaughtered and given ante and post-mortem 
inspections at the municipal abattoir. Six hundred and eighty-five 
were condemned as unfit for food on account of the following condi- 
tions: Cysticercosis, 464; cholera, 189; icterus, 4; septicemia, 12; 
sunstroke, 16. 

Quarantine inspections were given 9,802 cattle and 2,707 hogs that 
were shipped to Colon. Hide inspection certificates were given on 
11,932 hides for shipment. 

Diphtheria immunization. — This special work was continued during 
the year, as follows: 1st injections, 12,844; 2d injections, 1,167; 3d 
injections, 766. Total injections, 14,011; positive reactors, 1,160. 

Garbage. — During the year, garbage, rubbish, and manure to the 
amount of 36,877 tons were disposed of. Of this amount, 29,851 tons 
were from the city of Panama and 7,026 tons were from the Canal 
Zone, including Fort Amador. The cost of collection per ton in Pana- 
ma City was $1.50; in the Canal Zone, $2.54. The cost of disposal 
was $0.50 per ton. 

REPORT OF THE HEALTH OFFICER— CRISTOBAL-COLON. 

Dr. Jesse C. Ellington, Health Officer. 

Personnel. — The personnel of this office consists of the following: 
Americans (white), 1 health officer, 1 nurse, 1 clerk, 2 veterinarians and 



72 

meat inspectors, 3 sanitary inspectors. Aliens (colored), 89 street 
sweepers, scavengers, sanitary patrolmen, etc. 

No changes in the personnel were made during the year, except 
the present Health Officer assumed charge of the office on July 29, 
relieving Dr. D. G. Sampson, who returned to his regular station at 
Pedro Miguel. 

Colon sanitation. — The force engaged is composed of 1 sanitary in- 
spector, 6 colored sanitary patrolmen, 1 laborer, and 3 scythemen, and 
has to do with the general sanitation of the city of Colon proper. This 
includes inspections of all alleys, patios, toilets, kitchens, etc., in the 
tenement houses, and the control of fly and mosquito breeding in the 
tenement district. The system of requiring house owners to provide 
adequate janitor service for their houses and having each house cleaned 
daily, with the Health Department confining its activities to inspec- 
tions, follow-up and advisory work, which was started during the 
latter part of 1930, was continued throughout the year. The city is 
divided into six districts, with a sanitary patrolman in each, whose- 
duty it is to notice general cleanliness of all buildings, alleys, patios, 
kitchens, toilets, etc., and look for evidences of mosquito, fly, or rat 
breeding. Whenever any sanitary nuisance is found the patrolman 
attempts to have it abated, but if unable to do so it is reported to the 
sanitary inspector in charge of the work. Each sanitary patrolman 
can cover his district in from five to seven days. On the whole, this 
system has worked very well, but there appears to be a need for some 
training for the sanitary patrolmen. Persistent violators of the 
sanitary regulations are brought before the Health Officer and fined. 
During 1931, fines to the amount of $242.50 were assessed, collected, 
and turned over to the municipal treasurer. 

Street cleaning and garbage collection. — One sanitary inspector and 63 
colored employees are engaged in this work. The collection of garbage 
from Cristobal and Colon is done every night, beginning in the 
residential sections at 10 o'clock, using 4 trucks and 21 men. Rubbish 
from the city is collected daily by the pick-up truck with 2 men. All 
garbage and rubbish is taken for disposal to the dump in Silver City,' 
where there is a gang of 17 men. All combustible rubbish is burned 
and garbage is buried. The method of garbage disposal is as follows: 
After being dumped by the trucks, garbage is spread and then 
covered by matting and a layer of dirt about a foot deep. Each night's 
haul is spread in one row, and four rows of garbage are maintained. 
This does away with haphazard methods of spreading and is a large 
factor in controlling fly breeding, as each row of garbage is further 
covered every fourth night before the larvae can complete their 



73 

development. This method also saves time and reduces expenses, as 
not as many laborers are required. Fly breeding is controlled by this 
method due to the heat generated in the decomposing garbage, plus 
spraying of the face of the dump with a mixture of crude oil 10 parts, 
kerosene and creosote 2 parts each, to kill the few "hoppers" that 
emerge. 

During the year, garbage and rubbish to the amount of 27,910 tons 
were disposed of at the dump. Of this amount, 21,295 tons were from 
the city of Colon and 6,615 tons from the Canal Zone, including 
France Field. The cost of collection per ton in Colon was $1.51, and 
the cost of disposal, 54 cents per ton. The operation of the dump was 
satisfactory throughout the year, with the exception of a few fires due 
to spontaneous combustion. These fires are persistent and require 
the time of about three men for about two or three hours a day in con- 
trolling them. To control them both the "dry" method, that is, 
covering with earth to exclude air, and the "wet" method of saturating 
the burning area with water have been tried, and the results so far 
seem to indicate that the "wet" method is preferable in that it more 
adequately excludes oxygen and takes less time to control the fires. 

The street cleaning department was reorganized during the year 
and several changes were made in the methods of sweeping the streets. 
These changes were made to overcome the following defects in the old 
system: (a) Lack of a definite system, resulting in overlapping of the 
work, neglect of some streets, inability to detect slow or inefficient 
workmen, and inability to fix the blame in case of dirty or carelessly 
cleaned streets, (b) Loss of time by men traveling between the one 
place of checking in and their places of work, (c) Inability of the 
sweepers to scrape up hardened manure, etc., from the streets with the 
wooden backs of the brooms. 

To meet these objections, the sweeping gang of 21 men was divided 
into 7 groups of 3 men each. Each group, with one or two exceptions, 
was assigned to an area 2 city blocks wide and approximately 9 blocks 
long, extending east and west across the city from Front Street to 
"G" Street and New Colon. The exceptions were in cases of thinly 
populated areas, such areas being apportioned according to the 
amount of work and travel time involved. This did away with 
overlapping and made it possible to fix blame in cases of neglected 
streets. Each group begins at Front Street and works east, and as 
there is approximately the same amount of work in each district, all 
the groups make about the same progress, so slow or indifferent work- 
men are easily detected and it is also easy to locate the men at any 
hour. To do away with objection (b) the men were assigned to groups 



74 

according to the section of the city in which they lived and having four 
of the groups check in at a tool house near the Health Office. This 
eliminates unnecessary loss of time in men traveling to their places of 
work. To enable the men to better scrape up manure, etc., from the 
streets, a metal strip, or scraper, was attached to the back of each 
broom. Metal plates were also fastened to the ends of the brooms 
to prevent the wearing off of the end fibers by the low concrete 
curbs. These plates have resulted in much longer life of the brooms. 
Three of the principal streets in Colon are cleaned four times a day on 
week days and three times on Sundays. The five streets next in impor- 
tance are cleaned three times a day on weeks days and twice on 
Sundays. The other streets are cleaned twice daily on week days 
and once on Sundays. 

The inspector in charge of this work also does the mosquito and rat 
work. He has one silver man as larva hunter and rat trapper. 

During the year, 3,664 traps were set; 683 rats were caught of which 
410 were sent to the Board of Health Laboratory for examination. 

During the month of March, 110 rat-poison baits, the lethal ingre- 
dient of which was arsenic, were set out on the mole at Cristobal and 
in the dry dock and corral at Mt. Hope. Fifty-three were recovered 
intact, 36 were lost in ground holes, leaving only 21 partially or com- 
pletely eaten by rats. After using this poison no dead rats were seen 
or smelled in these places. In one of them (the corral) 10 traps were 
set the day after the bait was used and 4 rats were caught. The 
figures are not impressive, but it would seem to indicate that the poison 
bait is not very attractive to rats and further experiments are indicated. 

The practice of investigating all mosquito complaints was continued 
throughout the year. In most of these cases some cause was found, 
either in mosquito breeding on the premises in pots, vases or other con- 
tainers holding water, or in adjacent buildings. Routine mosquito 
catching and hunting of larvae was continued all over the city during 
the year. 

Mt. Hope cemetery. — The cemetery work during the year was chiefly 
routine work of burials and maintenance. There were 512 burials.* 
Receipts from burials were $3,692, from sale of flowers, $721.51, and 
miscellaneous receipts, $10. Much new land was cleared of bush and 
made ready for use. To reach this new area, partial grading and drain- 
age of a prospective road was done. 

Building work. — There were 1,028 building permits issued as follows: 
New buildings and major repairs, 118; minor repairs, 910. 

All these were closely followed up to see that the sanitary regulations 
regarding toilets, ventilation, rat-proofing, etc., were followed to the 



75 

letter. Inspections were also made of all buildings the leases of 
which expired during the year. 

Sanitation in vicinity of Canal quarters. — This work consists of 
nuisance abatements in Cristobal, Silver City, Camp Bierd, and New 
Cristobal, cleaning of garbage cans in Panama Canal quarters, and 
cleaning of beaches. Mosquito breeding in wash tubs in Panama 
Canal quarters, which had been troublesome, was eliminated through 
the cooperation of the District Quartermaster in grading the bottoms 
of the tubs to insure drainage. 

Dairies. — There are 19 dairies, including the Panama Railroad dairy 
at M indi, which supply about 1 ,000 gallons of milk daily to this district. 
The majority of the dairies are located along the coast near the village 
of Cativa, and on the shores of Gatun Lake. They all meet the mini- 
mum requirements of the sanitary regulations and were under the 
supervision of the Health Department during the year, although in- 
spections were not as frequent as is desired, due to their inaccessibility. 

The tuberculin test was given to 2,268 cattle during the year and 8 
reactors were found and subsequently slaughtered. During the year, 
the use of a chlorine solution for washing milk cans, bottles, other uten- 
sils, and milkers' hands was started. Cooperatidn of the dairymen was 
fairly good and results are shown in the decreased bacteria counts of 
the milk reaching Colon. No attempt was made to examine all dairy- 
men and milk handlers for possible disease carriers because all the milk 
is pasteurized before use. 

All milk is brought to Colon in boats, trucks, and by mule back and 
pasteurized in three modern pasteurizing plants, two of which are 
privately owned and the third is the Panama Railroad plant at Mt. 
Hope. The bacteria count of the milk reaching these plants was cor- 
related with the time period between milking and the time of arrival 
at the plant. After pasteurization the average bacteria count was 
from 20,000 to 30,000. During the year, 421 inspections of dairies 
and milk plants were made, an average of 19 inspections per plant per 
year. Two completely new dairies were constructed during the year 
and repairs and improvements were made to several others. Two new 
pasteurizers and a new bottle washing machine were added to the 
equipment at the Mt. Hope plant. 

Ice cream. — There are five plants manufacturing ice cream in this 
district, and ice cream made in Panama was sold by two dealers. Two 
hundred and twenty-seven inspections of the five plants were made to 
insure the purity of raw materials used and their handling in a sanitary 
manner. All ice cream mix is pasteurized. Samples of ice cream were 
taken at frequent intervals for bacteriological examinations and butter 



76 

fat content. The results of the bacteriological examinations are shown 
in the following table: 



Colonies of bacteria per c.c. 


Number of 
samples 
examined. 


Per cent 
of samples 
examined. 


100,000 and under 


52 
6 
G 
3 


77.7 


100,000 to 200,000 


8.9 


200,000 to 300,000 


8.9 


300,000 to 400,000 


4 5 








Total 


67 


100 



In view of the fact that legal bacterial standards for ice cream in 
various cities of the United States range from 100,000 to 800,000, it is 
obvious that ice cream produced in this district is of excellent quality 
as regards bacteria and it all meets the regulation requiring 8 percent 
butter fat. 

Soft drinks. — There are seven plants, including the one of the Com- 
missary Division, that bottle soft drinks in this district. Four hundred 
and two inspections of them were made during the year and monthly 
specimens were taken for bacteriological examination. Samples of" 
washing solutions were also taken monthly, or oftener, for determina- 
tion of the alkali content. During the year a campaign was begun to 
have all soft drink bottling plants install automatic filling and capping 
machines and bottle washing machines. This was successful, with 
three new outfits installed. Only one plant is without a bottle washing 
machine, which has been ordered. Other minor sanitary improve- 
ments were made in all soft drink manufacturing plants. 

Food inspections, markets, etc. — Inspection of food was carried on 
throughout the year and the following foodstuffs were condemned and 
destroyed as unfit and dangerous to the public health : Meat (fresh and 
salt), 9,418 lbs. ; English walnuts, 125 lbs. ; figs, 200 lbs. ; candy, 500 lbs. ; 
onions, 3,300 lbs.; plantains, 200 lbs.; yucca, 4,700 lbs.; potatoes, 1,800 
lbs. ; dairy feed, 300 lbs. ; grapes, 2,400 lbs. ; bananas, 1 stem; carrots, 1 
crate; cabbage, 2 crates; lettuce, 10 crates; cantaloupes, 5 crates; 
celery, 2 crates; pears, 20 crates; pineapples, 1 crate; milk, 22 tins. 

Markets, meat shops, bakeries, restaurants, soft drink stands and 
other places handling food are under Health Department supervision* 
and inspections were as follows: Restaurants and soft drink parlors, 
3,041; bakeries, 585; markets and stores, 1,001. 

There was gradual improvement in the sanitation of food places 
during 1931 and there were very few prosecutions for violations of the 
sanitary regulations, as warnings to the owners usually resulted in 
elimination of any insanitary conditions. 

Meat inspection, Colon abattoir. — During 1931 there were 4,190 cattle 
slaughtered, of which 4,147 were passed and 43 were condemned as 
unfit for food on account of the following conditions: Actinomycosis, 1 ; 



77 



died in pen, 4; emaciation, 18; extensive bruises, 8; gangrene, 3; pneu- 
monia, 2; septic wounds, 4; tuberculosis, 3. 

Parts condemned: Parasitic livers, 295; bruised quarters, 8; head, 
actinomycosis, 1. 

Also, 6,007 hogs were slaughtered and 5,640 were passed, 367 being 
condemned as unfit for food on account of the following conditions: 
Cholera, 119; cysticercosis, 112; died in pen, 83; emaciation, 12; ex- 
tensive bruises, 6; icterus, 2; melanosis, 1; pneumonia, 15; pyemia, 4; 
septic condition, 1; septicemia, 12. 

Meat inspection, Mt. Hope abattoir. — There were 6,268 cattle 
slaughtered during the year, of which 6,251 were passed and 17 were 
condemned as unfit for food on account of the following conditions: 
Died in pen, 4; emaciation, 4; gangrene, 1; icterus, 1; pneumonia, 1; 
pyemia, 1 ; septicemia, 2 ; tuberculosis, 1 ; extensive bruises, 2 ; 

Parts condemned: Parasitic livers, 199; bruised quarters, 12; heads, 
actinomycosis, 7. 

Also, 9,460 hides were examined and certificates issued for their 
shipment. 

Veterinary quarantine inspections. — Inspections of the following ani- 
mals entering the port of Cristobal were made and certificates issued : 
Cattle, 3,228; horses, 78; mules, 156; hogs, 26; sheep, 34; dogs, 2; 
monkeys, 7; tigers, 2; tapir, 1; lion, 1; parrots, 8. 

Sanitation of swimming pools. — There are two pools in the city, both 
of which were under supervision throughout the year. Two water 
samples from each pool were taken weekly for bacteriological examina- 
tions. The pools are thoroughly scrubbed weekly, the water is chlori- 
nated, and otherwise they are kept in a sanitary condition. 

Some work was done on investigating the amount of pollution of the 
bathing beaches in Colon and New Cristobal by the discharge of raw 
sewage into the bay. Bacteriological examinations of the water have 
been made, but the results as yet are not conclusive or of a sufficient 
quantity to draw conclusions. 

Communicable diseases. — The following table shows the number of 
cases of communicable diseases that were reported in Colon during 
1931 and 1930: 



Disease. 



Chicken pox 

Diphtheria 

Dysentery, amebic 

Dysentery, bacillary 

Malaria 

Measles '. 

Meningitis, meningococcus. 
Leprosy 

1 Deaths only. 



Year. 



1931. 



1930. 



105 
43 
5 
3 
107 
49 
4 



Disease. 



Mumps 

Pneumonia » 

Poliomyelitis 

Scarlet fever. 
Tuberculosis ' . . . 

Typhoid fever 

Whooping cough . 



Year. 



1931. 



1930. 



78 

The above table shows a marked decrease in the incidence of chicken 
pox, diphtheria, and malaria, and a slight increase in the number of 
deaths from tuberculosis. The decrease in diphtheria is believed due 
to the immunization of many children in Colon with toxin antitoxin, 
which was completed early in 1931. The increase in deaths from 
tuberculosis is no doubt explained by the adverse economic conditions 
prevailing during 1931, which caused widespread unemployment with 
its resultant malnutrition. 

Health conditions were very good throughout the year and there 
were no epidemics. The communicable diseases occurring were mild 
and complications and deaths were very rare. 

Total death rates, maternal and infant mortality. — Statistics on death 
rates, etc., will be found in the statistical section. Due to the un- 
certainty of the exact population of Colon, too much reliance can not 
be placed on the total death rates, but the figures compare very favor- 
ably with cities in the southern part of the United States which have 
above 25 per cent negro population. 

The maternal deaths include two from abruptio placenta, two from 
toxemia of pregnancy, one from eclampsia, and one from septicemia. 
An exceptionally large number of deliveries in Colon are made by mid- 
wives and the women have practically no prenatal care, yet the 
maternal death rate is low and probably could be still further reduced- 
if there were better facilities for prenatal care for the poor. 

Infant mortality in Colon has been gradually decreasing, especially 
deaths from diarrhea and enteritis and pulmonary infections. However, 
these causes are still large factors. Infant deaths from malnutrition 
and congenital causes, however, are apparently not decreasing, and it 
is believed that further reductions in the infant mortality rate can only 
be looked for in more education of mothers in infant feeding and im- 
proved clinical facilities for prenatal care and treatment of syphilis. 
The leading causes of infant deaths are as follows: 



Cause of death 



Prematurity 

Diarrhea and enteritis 

Congenital causes (miscellaneous). 

Pneumonia and bronchitis 

Malnutrition 

All other causes 



Per cent 
of total 
deaths ot 
infants. 



25 
21 
18 
13 
11 
12 



Free clinic. — The Health Department, in cooperation with the Cris- 
tobal Woman's Club, operates this clinic chiefly for prenatal, infant, 



79 

and preschool work among the poor of Colon. However, medical 
and minor surgical work among the adult poor is done as far as time 
and funds permit. The health officer is director of the clinic, with the 
nurse in direct charge. The following is a record of formulas prepared 
and work done during 1931 : 

Feedings (formulas) for infants 9,568 

Infants and preschool children, medical and surgical treatments 2,658 

Prenatal and postnatal cases treated 249 

Eye, ear, nose and throat treatments 575 

Eye and ear cases referred to Dr. Eno 107 

Dental cases referred to Dr. Doten 70 

Cases referred or sent to hospitals 434 

Medical and surgical treatments (adults).— 1,858 

The number of infants and preschool children attending the clinic 
for care and treatment increased approximately 25 per cent over the 
previous year and it is believed that continued work along this line will 
result in a further decrease in the infant mortality. Acknowledg- 
ment is made of the help of Dr. Harry Eno and staff of the Samaritan 
Hospital, and Dr. H. A. Doten, who donated their services for the 
eye, ear, nose and throat work and the dental work, respectively. 

The following work was also done by the district nurse: Routine 
smallpox vaccinations, 2,374; typhoid immunizations, 114; home visits 
(communicable diseases, maternal and infant work) 3,910; specimens 
taken to be sent to laboratory, 653. 

REPORT OF THE DIVISION OF QUARANTINE FOR THE 

CALENDAR YEAR 1931. 

Dr. M. Flint Haralson, Surgeon, U. S. P. H. S., Chief Quarantine 

Officer. 

There was no change in quarantine procedure during the past year. 
As in preceding years, all vessels entering the ports of Balboa and 
Cristobal, except those granted radio pratique, were boarded upon 
arrival by quarantine officers. 

Inspection of vessels, passengers, and members of the crew was 
made to prevent the introduction of any of the quarantinable diseases 
into the Canal Zone. It was not necessary to detain any vessel or any 
person on board an arriving vessel on account of the presence of such 
a disease. During a portion of the year it was deemed advisable to 
maintain more strict supervision over all vessels and persons arriving 
at Cristobal from Colombian ports on account of the reported presence 
of a disease; resembling in some respects yellow fever, in the province 
of Santa Marta. Nothing of a suspicious nature was detected. 



80 



The medical officers attached to the Division of Quarantine also 
serve as immigration officers of the Panama Canal. In the performance 
of this duty the division cooperates with the Republic of Panama in 
the enforcement of their immigration laws. All persons destined for 
Panama who have complied with immigration requirements for the 
Republic are discharged directly from the vessel upon which they 
arrive. When regulations have not been satisfied, such persons are 
temporarily detained pending action by the proper Panamanian 
authority. 

The volume of work performed by the Division of Quarantine was 
materially less than that done during the previous year, since 1,085 
fewer vessels entered the two ports. The number of persons entering 
the Canal Zone was correspondingly decreased, a total of 61 7,393 having 
entered in 1930 and 547,310 during the current year. However, 282 
more persons were detained at the quarantine station on account of in- 
fraction of immigration regulations than were detained during the 
preceding year. 

The following table summarizes the activities of the division for the 
year 1931 : 

REPORT OF DIVISION OF QUARANTINE FOR CALENDAR YEAR 1931. 



Balboa. 



Cristobal. 



Total. 



Vessels inspected and passed 

Vessels granted pratique by radio 

Vessels passed on certificates of masters 

Vessels issued provisional pratique 

Total 

Crew inspected and passed 

Crew passed by radio 

Crew passed on certificates of masters 

Passengers inspected and passed 

Passengers passed by radio 

Passengers passed on certificates of masters 

Total 

Airplanes inspected and passed 

Crew of airplanes inspected and passed 

Passengers of airplanes inspected and passed 

Total 

Vessels detained in quarantine 

Crew detained in quarantine on board ship 

Passengers detained in quarantine on board ship 

Crew admitted to station account of quarantine laws 

Passengers admitted to station account of quarantine laws 

Number of detention days at station for year 

Persons admitted to station account of immigration laws. 

Number of detention days for year 

Persons held or detained for investigation and released 
Persons deported under immigration laws 

Supplementary sanitary inspection of vessels 

Vessels fumigated 

Box cars fumigated 

Number of rats recovered after fumigation 



548 

121 

2,000 





2,675 



24,507 
30,238 
111,523 
10,817 
436 
31,253 



208,774 



26 















1,070 

5,315 

146 

431 



434 

15 

6 

78 



3,252 
91 
22 




3,365 



83,709 
29,728 
130,563 
78,165 
5,325 
10,202 



337,692 



382 



857 
901 



1,818 











109 
653 



3,171 
42 
139 
90 



3,800 

212 

2,028 





6,040 



108,216 
59,966 

242,086 
88,982 
5,761 
41,455 



546,466 



387 



871 
913 



1,844 















1,070 

5,315 

255 

1,084 



3,605 
57 
145 
168 



81 



REPORT OF DIVISION OF QUARANTINE FOR CALENDAR YEAR 1931— Continued. 




Balboa. 


Cristobal. 


Total. 


lations issued: 


695 
4,521 

781 
5,776 








695 




4,521 
781 






5,776 






Total 


11,883 





11,883 







rotal cost of rations $4,701.40 

Average daily cost, each ration .40 



REPORT OF DISTRICT NURSE. 
Miss Louisa Kurath, Public Health Nurse, Pacific District. 

The public health nurse has continued to supervise the operation of 
the five baby clinics once each week. While there has been a slight de- 
crease in the average monthly enrollment of infants and young children, 
the number of visits to the clinics has practically doubled during the 
year. Mothers are urged to bring their babies to a clinic each week for 
regular weighing and measuring. They are advised as to methods of 
care and supervision. Dietary precautions and feedings are discussed 
and matters relating to personal hygiene are brought to their atten- 
tion. Timely pamphlets and reading matter are distributed as in- 
dicated, and every effort is made to encourage mothers to increase their 
knowledge in the general care and rearing of their children. 

The nurse assisted in the annual medical examination of school 
children, devoting the morning hours to this work during the period 
of examination. She continued to give health talks to classes in the 
various schools to complete the series begun last year. 

All cases of tuberculosis are reported to the nurse, and periodic visits 
to the homes of such patients are made to advise the family as to 
the proper care of the patient and to insist upon the necessary precau- 
tions for the protection of other members of the family. 

The public health nurse organized a class of colored girls in La Boca 
during March and supervised their instruction in the course of home 
hygiene and care of the sick as prepared by the American Red Cross 
Society. This class continued its work through the month of June. 
At the termination, and following a written examination, Red Cross 
certificates were issued to 18 members of the class. 

In addition to the activities mentioned above, the nurse visits all 
registered midwives on the Pacific side of the Zone. She checks their 
work, gives them instruction, and insures compliance with the re- 
quirements. 

MR 31053 6 



82 

The following table summarizes the activities of the public health 

nurse for the year 1931 : 

Number of baby clinics 5 

Average number of babies enrolled per month 431 

Average number of babies visiting clinics per month.. 226 

Total number of visits to clinics. ._ 5 , 130 

Number of visits to cases of tuberculosis 85 

Total number of house visits - 1 .074 

Number of talks given in schools — 38 

MEDICAL EXAMINATION OF SCHOOL CHILDREN, 1931 

Owing to lack of funds the Health Department was unable to ap- 
point a regular school physician. All of the white school children of 
the Canal Zone were examined by a physician of the Quarantine 
Division assigned to this duty. The fact that the same physician made 
the examinations on both the Atlantic and Pacific sides of the Zone 
insured more uniform noting of defects than has been the case in 
the past when one examining physician did the work on the Altantic 
side and another on the Pacific. 

A total of 2,621 American children (white) were examined, 1,023 of 
whom were in attendance at schools on the Atlantic side of the Zone 
and 1,598 on the Pacific side. There were examined 1,400 boys and 
1,221 girls. 

The most prevalent defect observed was in the condition of the teeth. 
Practically one-fourth of all children were noted as having defective 
teeth. This includes children with one or more carious teeth, either 
temporary or permanent, or teeth in faulty position. 

The second most common defect was in weight. The age-height- 
weight scale as accepted in the United States was used for obtaining 
this figure. Children more than 10 per cent above or below the average 
for this scale were classified as defective in weight, the majority being 
underweight. It is not believed that the percentage recorded is a true 
indication of the local condition because the Health Department feels 
that the normal average weight of Canal Zone children is noticeably 
less than for children of the same age in the temperate climate of the 
United States. 

The percentage of children suffering with defective tonsils appeared 
to be rather high. Notices were sent to parents only in the cases where 
it seemed advisable to have the children referred to a throat specialist 
for treatment. 

The majority of ear conditions were the result of fungus growth or 
impacted cerumen. Very few children with defective hearing were 
found. 



83 

All boys were examined for phimosis and hernia. There were 
148 found to have elongated prepuces but only one to have hernia. 

The examination of the children in the colored schools will begin in 
the early part of 1932. 

LEAD POISONING. 

As the Panama Canal employs a considerable number of individuals 
who habitually handle lead products, a special study was made of this 
subject in 1931 with a view to determining whether the precautionary 
measures in force were adequate to prevent lead poisoning. 

One of the features of the study was a survey in hospital of all em- 
ployees whose work involved habitual exposure to lead paints, pow- 
dered lead products, or lead fumes. The survey included a general 
physical examination and special examinations of the blood, urine, and 
nervous system to exclude objective or subjective symptoms of lead 
poisoning. The minimum stay in hospital was 2 days. A total of 240 
individuals was examined and of this number 5 presented symptoms 
of lead poisoning. Three of these individuals were known to have 
lead poisoning at the time the survey was undertaken. The survey 
therefore brought to light only 2 new cases of lead poisoning or less 
than 1 per cent of the 240 men examined. 

It was planned to institute annual surveys of this nature provided 
the first survey showed any material number of cases. 

The results Obtained from the initial survey, only 2 cases of 240 
examined, show that the safeguards now in force afford such a high 
degree of protection that annual surveys will not be required. 

The instructions now in force relative to the prevention of lead 
poisoning in employees of the Panama Canal are incorporated in the 
following circular: 
To all concerned: 

PROTECTION OF EMPLOYEES AGAINST LEAD POISONING. 

1. In view of the fact that occasional cases of lead poisoning occur among painters 
and others in the employment of The Panama Canal who work with lead products, 
the following measures will be taken to reduce this hazard: 

2. Prior to employment all applicants for positions that involve habitual exposure 
to lead paints, powdered lead products, or lead fumes, will be directed to report to a 
Panama Canal hospital for examination for evidence of previous lead poisoning, and 
for examination of their fitness for such employment. 

3. The following instructions will be imparted to all employees who are liable 
to exposure to the danger of lead poisoning: 



Lead poisoning is a dangerous disease which results from the introduction of 
compounds of lead into the body. This introduction may be by breathing powdered 



84 

lead products or lead fumes into the lungs; through the mouth by swallowing particles 
of lead when eating or smoking; or possibly by absorption through the pores or cuts 
in the skin. The greatest care is necessary on the part of all people who handle lead 
compounds in order to prevent lead poisoning. The following precautions are hereby 
prescribed to be followed by all persons handling lead : 

(a) All paint, red lead putty, dry pigments, and metallic lead particles should be 
thoroughly removed from the face and hands when stopping work for lunch and at 
the close of the day's work. If necessary, kerosene or petroleum spirits should be 
used for removing paint; but soap and water should always be used. 

(b) Special working clothes should be worn by painters, paint mixers, and others 
working with paint or powdered lead. These clothes should be worn only when 
working, should not be kept in the same locker or depository as are the clothes worn 
to work, and they should be washed frequently enough to keep them reasonably 
clean. 

(c) All employees should guard against getting lead in the mouth when eating 
food, smoking, chewing tobacco, eating fruit, etc. 

(d) Employees in paint mixing rooms must wear respirators when dry pigments 
are being handled. 

(e) Floors, platforms, tables, etc., in paint mixing rooms must be kept clean and 
free of dust at all times. Mops and brooms used for cleaning purposes must be 
dampened to prevent stirring up dust. 

(/) Lead burners and acetylene cutters should guard against inhaling fumes while 
at work. 

(g) Employees having any of the following symptoms should report the fact to 
their foreman as any one or more of these complaints may indicate beginning lead 
poisoning — 

Persistent headache, cramps in abdomen, soreness of mouth, constipation, 

loss of energy, muscular tremor, loss of strength of wrists. 

4. Supervisors of men engaged in occupations involving danger of lead poisoning 

will by means of frequent inspections assure themselves that the above instructions 

are being carried out; and they will immediately send to a dispensary for examination 

any employee reporting symptoms of lead poisoning. 

H. Burgess, 

Governor. 



GENERAL TABLES. 

Table 1.— DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES 
FOR EMPLOYEES. 

ABSOLUTE NUMBERS. 





"3 

1 

a s 

II 

•< 


Discharges from and 
deaths in hospitals. 


Total deaths. 


8 . 

■° S 
•S-2 

i = 
i ^ 

S-T3 
£ OS 

Q 






3 

o 


c 

I 

5 


i 

■a 

*03 

a 

w 


"3 
o 
H 


5 


8 

~5 

1 


"■■a 

Ss » c 
<! 


Year 1931: 

White 


3,551 
11,046 


1,201 
2,440 


1,102 
2,069 


99 
371 


27 
106 


21 
96 


6 
10 


22,849 
59,450 


62.60 


Black 


162.88 






Total 


14,597 


3,641 


3,171 


470 


133 


117 


16 


82,299 


225.48 


Year 1930: 

White 


3,589 
11,935 


1,123 
2,547 


1,034 
2,145 


89 
402 


29 
151 


27 
148 


2 
3 


19,949 
64,451 


54.65 


Black 


176.58 






Total 


15,524 


3,670 


3,179 


491 


180 


175 


5 


84,400 


231.23 







ANNUAL BATE PER 1,000 EMPLOYEES. 



Year 1931: 

White 




338.21 
220.89 


310.33 
187.31 


27.88 
33.59 


7.60 
9.60 


5.91 
8.69 


1.69 
.91 




17.63 


Black... 




14.75 








Total 




249.43 


217.23 


32.20 


9.11 


8.02 


1.09 




15.45 








Year 1930: 

White 




312.90 
213.41 


288.10 
179.72 


24.80 
33.68 


8.08 
12.65 


7.52 
12.40 


.56 

.25 




15.23 


Black 




14.80 








Total 




236.41 


204.81 


31.63 


11.59 


11.27 


.32 




14.90 









85 



UMonjfUj} 



3J!1 



86 



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Tablb 3— DEATHS AND DEATH RATES OF RESIDENTS OF THE CANAL ZONE AND THE CITrES OF 

PANAMA AND COLON. 



Place. 


Popula- 
tion. 


Deaths. 


Annual rate per 1,000 
population. 




Total. 


Disease. 


External 
causes. 


Total. 


Disease. 


External 
causes. 


Year 1931: 


76,000 
30,000 
40,565 


1,341 

482 
305 


1,274 
457 
247 


67 
25 
58 


17.64 
16 07 

7.52 


16.76 
15.23 
6.09 


.88 




83 




1 43 






Total 


146,565 


2,128 


1,978 


150 


14.52 


13 50 


1.02 


Year 1930: 

Panama 


74,402 
29.765 
39,469 


1,307 
518 

282 


1,251 
490 
242 


56 
28 
40 


17.57 
17.40 
7.14 


16.81 
16.46 
6.13 


.75 
.94 




1.01 






Total 


143,636 


2,107 


1,983 


124 


14.67 


13.81 


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104 



Tablb 7— STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES, 1931. 





Annual 
death rate 
per 1,000. 


White employees from the United States: 


5.45 




1 21 






Total 


6.66 






Families of white employees from the United States: 


3.16 




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Total 


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White employees from the United States and their families: 


3.97 




.86 






Total 


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Number of American children born on the Isthmus during the year 

Deaths among American children under 1 year of age 

Infant mortality rate among American children (number of deaths per 1,000 live births) . 



199 

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126 



Table 10.— NUMBER OF DAYS HOSPITAL TREATMENT FURNISHKD AND AVERAGE NUMBER IN 
HOSPITAL EACH DAY OF THE VARIOUS CLASSE8 OF PATIENTS. 1931. 





Number of days treatment. 


Average 


number in 


hospital each day. 


Class of patients. 


Ameri- 
can. 


Foreign. 


Black. 


Total. 


Ameri- 
can. 


Foreign. 


Black. 


Total. 


Oorgas Hospital: 


10,285 

41,835 

2,560 


3,561 


28,202 


42,048 
41,835 

2,560 
917 

9,809 
67,881 


28.18 

114.62 

7.01 

10.76 
40.00 


9.76 


77.27 


115.20 




114.62 












7 01 




27 
1,634 
9,743 


890 

4,246 

43,538 


.07 

4.48 

26.69 


2.44 

11.63 

119.28 


2.51 




3,929 
14,600 


26.87 




185.98 






Total 


73,209 


14,965 


76,876 


165,050 


200.57 


41.00 


210.62 


452.19 






Corozal Hospital: 




365 


5,756 


6,121 

3,082 

210 

172,940 

10,612 

35,362 


8.44 
.58 

1.58 
5.74 


1.00 


15.77 


16.77 




3,082 
210 

576 
2,094 


8.44 












.58 


Panamanian Government 


31,850 
3,792 
6,898 


141,090 

6,244 

26,370 


87.26 
10.39 
18.90 


386.55 
17.11 

72.25 


473.81 
29.07 




96.88 






Total 


5,962 


42,905 


179,460 


228,327 


16.33 


117.55 


491.67 


625 55 










1,095 
1,293 


8.405 
19,090 


9,500 
20,383 




3.00 
3 54 


23.03 
52.30 


26.03 






55.84 


Colon Hospital : 


1,290 

9,117 

938 

4,519 


238 


' 5,104 


6,632 
9,117 
4,738 
21,021 


3.53 
24.98 

2.57 
12.38 


.65 


13.98 


18 17 




24.98 




404 
1,914 


3,396 
14.588 


1.11 
5.24 


9.30 
39.97 


12.98 




57.59 






Total 


15,864 


2,556 


23,088 


41,508 


43.46 


7.00 


63.26 


113.72 






Palo Seco Leper Colony: 




706 


27,171 
7,070 


27,877 
7,070 




1.93 


74.44 
19.37 


76.38 






19.37 












Total 




706 


34.241 


34,947 




1.93 


93.81 


95.75 








Total by classes: 


11,575 

54,034 

2,770 

5,443 
21,213 


4,164 


39,062 


54,801 

54,034 

2,770 

201,734 

62,112 
124,264 


31.71 
148 04 

7.59 

14.91 
58.12 


11.41 


107.02 


150.14 




148 04 












7.59 


Panamanian Government 

Canal Zone Government, charity, 

All others 


32,583 

8,218 
18.555 


169,151 

48,451 
84,496 


89.27 

22.52 
50.84 


463.43 

132.74 
231.50 


552 70 

170.17 
340.44 




95,035 


63,520 


341,160 490 715 


260.37 


174.03 


934.68 


1,369.08 













Table 11.— CONSOLIDATED REPORT OF ADMISSION, HOSPITALS AND DISPENSARIES, 1931. 



All classes of patients. 


White. 


Black. 


Total. 


Admissions to hospitals, excluding Corozal farm (cripples and chronic ward) 


8,655 
2,741 


8,396 
4,020 


17.051 
6.761 








11,396 


12,416 


23,812 






Less number of patients transferred between hospitals and from quarters to 


353 


481 


834 








11,043 


11,935 


22,978 






Employeee only. 


1,243 
2,741 


2,584 
4,020 


3,827 




6,761 








3,984 


6,604 


10,588 






Less number transferred between hospitals and from quarters to hospitals, whose 
admissions are duplicated in the above figures 


58 


233 


291 




3,926 


6.371 


10,297 






Annual admission rate per 1,000 employees to hospitals and quarters 


1.056.04 


576.77 


705.42 



127 

Table 12— REPORT OF DISPENSARIES, 1931. 

EMPLOYEES TREATED IN QUARTERS. 



Dispensary. 


Remaining 

January 1, 

1931. 


Admitted. 


Died. 


Discharged. 


Transferred. 


Remaining 
December 
31, 1931. 




White. 


Black. 


White. 


Black. 


White. 


Black. 


White 


Black. 


White. 


Black. 


White. 


Black. 




3 
1 


7 
5 


721 
1,063 
129 
174 
654 


1,327 

1,061 

405 

212 

1,015 






695 
1,060 
129 
174 
661 


1,228 

1,060 

402 

212 
1,015 


25 


97 


4 
4 


9 








6 












3 






















10 


25 










3 


25 














Total 


14 


37 


2,741 


4,020 






2,719 


3,917 


25 


97 


11 


43 










• Dispensary fur 


nishing treatment, 


Days treatment furnished. 


Average number treated 
in quarters per day. 




White. 


Black. 


Total. 


White. 


Black. 


Total. 




1,793 

2,544 

298 

465 

2,010 


5,890 
3,244 
1,694 
1,097 
8,463 


7,683 
5,788 
1,992 
1,562 
10,473 


4.91 
6.97 
.82 
1.27 
5.51 


16.14 
8.89 
4.64 
3.00 

23.19 


21.05 




15.86 




5.46 




4.28 




28.69 








Total 


7,110 


20.388 


27,498 


19.48 


55.86 


75.34 

























ALL CASES TREATED. 



Dispensary. 


Employees. 


Nonemployees. 


Total. 


White. 


Black. 


Total. 


White. 


Black. 


Total. 


White. 


Black. 


Total. 




5,708 
9,478 
3,278 
3,802 
9,127 


19,326 
11,883 
8,228 
7,270 
16,805 


25,034 
21,361 
11,506 
11,072 
25,932 


6,966 
14,436 
6,433 
5,158 
15,782 


18,093 
9,713 

13,135 
8,991 

22,974 


25,059 
24,149 
19,568 
14,149 
38,756 


12,674 
23,914 
9,711 
8,960 
24,909 


37,419 
21,596 
21,363 
16,261 
39,779 


50,093 




45,510 




31,074 




25,221 




64,688 






Total 


31,393 


63,512 


94,905 


48,775 


72,906 


121,681 


80,168 


136,418 


216,586 







Table 13— AVERAGE NUMBER OF DAYS IN HOSPITALS AND QUARTERS FOR EACH ADMISSION, 

EMPLOYEES ONLY, 1931. 





White. 


Black. 


Total. 


Hospitals: 


13.69 
7.45 


16.94 
8.82 


15.83 




8.46 








12.66 


15.12 


14.32 






Quarters: 


2.49 
2.39 
2.31 
2.67 
3.07 


4.44 
3.06 
4.18 
5.17 
8.34 


3.75 




2.73 




3.73 




4.05 




6.28 








2.59 


5.07 


4.07 







MR 31053— Panama Canal— 11-17-32— 1,000